Pharmacy benefit manager change
We’re changing our pharmacy benefit manager
On January 1, 2024, we're changing our pharmacy benefit manager (PBM) — the company we use to manage your pharmacy benefits — to Navitus Health Solutions. This change will help you save on your drug costs, provide a better mail order pharmacy experience and give you access to a nationwide network of over 63,000 retail pharmacies. As we move forward with this transition, we want to make sure you’re informed and feel supported.
What you need to know
We’ll reach out to you if there are changes that require your attention.
If you have any questions, call us at the Customer Service number on the back of your member ID card.
We’ll mail you a new Aspirus Health Plan Medicare Advantage member ID card for 2024
Your new card — which we'll mail to you in the coming months — has your updated pharmacy billing information.
Bring your new card to the pharmacy the first time you fill a prescription in 2024 so they can update your information.
We’ll continue to manage the Formulary (List of Covered Drugs)
Most members won’t experience drug coverage changes. We'll reach out to you if there are changes that require your attention.
You’ll have access to 63,000+ retail pharmacies
Most members will be able to keep their pharmacy. Confirm that your pharmacy will be in our network or find a new pharmacy using our search tool.
We'll transfer your mail order prescriptions
As of January 1, 2024, Costco Mail Order Pharmacy will be your mail order pharmacy. We’ll transfer current eligible mail order prescriptions and reach out to you soon with more information. You don't need to be a Costco member to use this service.
Frequently asked questions
On a regular basis, we engage in a competitive selection process to identify a pharmacy benefit manager (PBM) partner. After rigorous review, we selected Navitus Health Solutions because they share our member-first approach, have nationwide pharmacy networks, partner with Costco Pharmacy for mail order services and have reduced drug costs while continuing to offer programs to keep our members healthy.
A pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs that help negotiate costs and payments between drug manufacturers, pharmacies and health insurance providers. We will still manage the Formulary (List of Covered Drugs).
The change to a new pharmacy benefit manager will mean few or no changes for most members, as the prescription medications we cover and the terms of coverage will remain the same for most medications. Also, most of our current network pharmacies will remain in network. If you’re going to be affected by the change, we’ll let you know by mail and we’ll guide you through any action you need to take.
Mail order pharmacy services
Beginning in 2024, we are teaming up with Costco Mail Order Pharmacy as our mail order pharmacy. You don't need to be a Costco member to use this service. If you currently use Express Scripts Mail Order Pharmacy, most of your prescriptions will transfer automatically. Some prescriptions won’t transfer automatically, including prescriptions with no refills remaining, prescriptions on file but never filled or fills for controlled substances. Look for information in the mail specific to your mail order fills for your next steps.
Formulary (List of Covered Drugs)
Aspirus Health Plan will continue to manage the Formulary — also known as the List of Covered Drugs or drug list. Most changes to the drug list occur on January 1. We regularly review and may make changes each month. This will continue with our new pharmacy benefit manager. Throughout the year, we might add or remove drugs from the drug list, move them to different cost-sharing tiers or add new restrictions. We’ll reach out to you if there are changes that require your attention.
On January 1, 2024, active Aspirus Health Plan members will be able to see all pharmacy claims paid by the new pharmacy benefit manager. To see these claims, log in to your Aspirus Health Plan Medicare Advantage online member account. Select the “My Pharmacy Benefits” tile on your dashboard and click on the link to visit the Navitus member portal. Once there, members can view their pharmacy claims in their Medication History section.
On January 1, active Aspirus Health Plan members will be able to look up drug coverage costs in real time, meaning the cost you see is a moment-in-time estimate of the out-of-pocket costs you are expected to pay. To use this tool, log in to your Aspirus Health Plan Medicare Advantage online member account. Select the “My Pharmacy Benefits” tile on your dashboard and click on the link to visit the Navitus member portal. Once there, enter a drug name in the "Get Started" pop up window, then enter your drug information and select a pharmacy. You can also call Aspirus Health Plan Customer Service for this information.
Before Costco Mail Order Pharmacy can begin filling your prescriptions on January 1, 2024, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. You don’t need to be a Costco member to use this service.
Create an account and patient profile through the Costco Mail Order Pharmacy website or call 1.800.607.6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — to complete the patient profile before you can order prescriptions. Your pharmacy billing information can be found on your 2024 member ID card or call Aspirus Health Plan Customer Service after October 1, 2023, and a Customer Service representative can provide the information you need. Once you have an account and patient profile, you can fill prescriptions with Costco Mail Order Pharmacy online or by phone on or after January 1, 2024.
If you currently use Express Scripts Mail Order Pharmacy, most prescriptions will transfer automatically. Some prescriptions won’t transfer automatically, including prescriptions with no refills remaining, prescriptions on file but never filled or fills for controlled substances. Look for information in the mail specific to your mail order fills for your next steps
Before Costco Mail Order Pharmacy can begin filling your prescriptions on January 1, 2024, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. You don’t need to be a Costco member to use this service.
Create an account and patient profile through the Costco Mail Order Pharmacy website or call 1.800.607.6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — to complete the patient profile before you can order prescriptions. Your pharmacy billing information can be found on your 2024 member ID card or call Aspirus Health Plan Customer Service after October 1, 2023, and a Customer Service representative can provide the information you need. Once you have an account and patient profile, you can fill prescriptions with Costco Mail Order Pharmacy online or by phone on or after January 1, 2024.
Costco offers an auto refill reminder program. After you begin filling prescriptions with Costco Mail Order Pharmacy, you can select "auto refill" for each medication you want to enroll in the program. After you select the auto refill option, you will be notified by email that it is time to refill. You will be able to click a link in that email to order your prescription refill. You must repeat this step for every refill on every medication you enrolled in auto refill.
Yes. The Costco Mail Order Pharmacy is a separate pharmacy service from the retail pharmacy in Costco stores. Before Costco Mail Order Pharmacy can begin filling your prescriptions on January 1, 2024, you will need to have or create a Costco account and Costco Mail Order Pharmacy patient profile. You don’t need to be a Costco member to use this service.
Create an account and patient profile through the Costco Mail Order Pharmacy website or call 1.800.607.6861 (TTY users call 711).You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — to complete the patient profile before you can order prescriptions. Your pharmacy billing information can be found on your 2024 member ID card or call Aspirus Health Plan Customer Service after October 1, 2023, and a Customer Service representative can provide the information you need. Once you have an account and patient profile, you can fill prescriptions with Costco Mail Order Pharmacy online or by phone on or after January 1, 2024.
You’ll have access to an extensive pharmacy network of over 63,000 pharmacies nationwide. Check that your pharmacy is in network or find a new pharmacy using our online search tool.