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Prescription Drug Benefit

The VUMC Health Plan includes prescription drug coverage - no need to enroll in a separate prescription plan. Navitus Health Solutions manages the pharmacy benefit and is committed to lowering drug costs, improving health and delivering superior service.

See:   • In-network pharmacies    • Covered drugs    • File a claim    •VUMC 2018 Navitus Pharmacy Booklet

In-Network Pharmacies

We recommend using Vanderbilt pharmacies, where you will get $1 maintenance generics and the best price for all other prescriptions.

  • The Vanderbilt Mail Order Pharmacy delivers prescriptions directly to your home. Shipping is free! To sign up, simply fill out the enrollment form. If you prefer, you can call 615.875.0078, and the staff can help you enroll.
  • Other Vanderbilt pharmacy locations (click here for details):
    • The Vanderbilt Clinic
    • Medical Center East
    • Monroe Carell Jr. Children's Hospital at Vanderbilt
    • Vanderbilt Health One Hundred Oaks

The Navitus pharmacy network includes most major retail pharmacies. Click here for a list of major retailers in the Navitus network.

While Vanderbilt pharmacies give us the best pricing using our employee health plan, we know that sometimes you need to use a non-Vanderbilt pharmacy. You can fill prescriptions at Walgreens at lower rates than other non-Vanderbilt pharmacies. As our preferred partner, Walgreens offers lower copays and coinsurance rates than other non-preferred pharmacies. The following prescriptions are offered exclusively through the Vanderbilt Pharmacy and will not be available at Walgreens:
                 • 90-day prescriptions*
                 • mail-order prescriptions
                 • specialty pharmacy prescriptions

* Beginning April 1, 2018, members of the VUMC Health Plan will be able to purchase 90-day prescription refills at all in-network pharmacies, including Walgreens.

Covered Drugs (Formulary)

The prescription drug benefit is a multi-level formulary (i.e., list of covered drugs) with a recommended generic program. Not all prescription drugs are covered by the plan and some require prior authorization from Navitus Health Solutions before the prescription can be filled.

The formulary is on the Navitus member website. Here's how to find it:

  1. Go to
  2. Click on the link for Members and then click on the link for Member Login
    • If you have already registered, enter your User ID and Password. Then answer the security question.
    • If you haven't registered yet, click on the link for Click here for new registrations. You will need your Navitus ID number, found on your Navitus card. You will need to create a userID and password (you can't use your first or last name, NavitusID number or birthdate in your userID or password).
  3. Once you have logged in with your user name and password, you will see the homepage of the Navi-Gate website.
  4. Click on the link for Formulary in the left column.
  5. You can download a Quick Reference Formulary or a Complete Formulary.

If you need help, contact Navitus Customer Care toll-free with the number listed on your Navitus card. Navitus Customer Care is open 24 hours a day, 7 days a week (closed Thanksgiving and Christmas Day).

Specialty Drugs

Coverage of specialty drugs is available only when filled through one of the Vanderbilt pharmacies. Specialty drugs typically treat very serious diseases. They include biotechnologically produced or genetically engineered drugs that require special storage and handling. Please contact Navitus Health Solutions for more information about specialty drugs or see the Vanderbilt Specialty Pharmacy website.

How to File a Claim

You can file a claim by U.S. mail or by fax.

By U.S. Mail

  1. Download the appropriate claim form:
  2. Complete the form. Incomplete forms will be returned without payment and with a request for additional information.
  3. Sign and date the Certification Statement.
  4. Submit a separate form for each family member.
  5. If the member has other insurance coverage, attach a copy of the Explanations of Benefits or Denial Notification from the primary insurance carrier.
  6. Keep a copy for your records.
  7. Mail the claim form along with the original pharmacy receipt, not the cash register receipt, to: Navitus Health Solutions, Operations Division - Claims, P.O. Box 999, Appleton, WI 54912-0999

By Fax

  1. Fax paper claims and pharmacy receipts (not cash register receipts) to 920.735.5315 (or toll-free at 855.668.8550).

If you have questions, contact Navitus Customer Care toll-free at the number listed on your pharmacy benefit ID card.