Pharmacy Benefit Information

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Questions? Contact Customer Service at (855) 645-8448

Pharmacy Benefit Information 

To find if your drug is covered, please click our Drug Lookup Tool below:

OptumRx Formulary Search 2020
Navitus Formulary Search 2021

(Please note that by clicking on the links above, you will be leaving the Memorial Hermann website).

Drug Formulary

Download our Comprehensive Drug Formulary* below:

2021 Comprehensive Drug Formulary

* Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. Not every drug approved for use by the FDA has been included in this listing. The listing of a medication in this formulary list does not guarantee coverage. To determine the most up-to-date formulary status of your medication, please call member services at the number listed on your ID card.

To learn more about our Drug Formulary, click here.

Pharmacy Network

To locate a pharmacy near you, use our Pharmacy Locator Tool in the links below:

Navitus Pharmacy Search

(Please note that by clicking on the links above, you will be leaving the Memorial Hermann website).

Additional Information

If you have questions about your drug formulary or need more information on how to obtain your medication, or to initiate an exception request, please call the Customer Service number on the back of your member ID card. See forms by scrolling down to the exception request section below.

Memorial Hermann Specialty Pharmacy

Memorial Hermann Specialty Pharmacy focuses on delivering high-quality, integrated care to help you achieve the best possible health by providing:

  • Timely and reliable delivery of your specialty medication from the locally based pharmacy in Katy.
  • Free delivery, regular refill reminders and important updates.
  • Knowledgeable, helpful staff to assist you with your specialty medication.
  • A pharmacy with a direct connection to Memorial Hermann providers, hospitals and clinics.

Learn more by visiting https://specialtypharmacy.memorialhermann.org/ and by reading their Frequently Asked Questions. You can also view the Specialty Pharmacy Medication List here, or please visit Memorial Hermann Specialty Pharmacy.*

*Please Note: The listing of a medication in this specialty drug list does not guarantee coverage. To determine the most up-to-date formulary status of your medication or if your medication is covered, please call member services at the number listed on your ID card.

Additional Specialty Services

Lumicera Specialty Pharmacy is another alternative specialty pharmacy benefit that we offer to our members. The process to fill a prescription is simple. Call a Lumicera Patient Care Specialist at (855) 847-3553 to get started.

Please go to the Lumicera Specialty Pharmacy Frequently Asked Questions page for additional resources.

Health Care Reform Preventive Care

Under the health reform law (Affordable Care Act), benefit plans must cover certain Preventive Care Medications at 100% - without charging a copay, coinsurance or deductible. This is a list of prescription and OTC drugs with a valid prescription that is required to be covered by ACA regulations at $0 copay at any network pharmacy.

2021 HCR Preventive Care

Costco Mail Order Information and Forms

Are you taking a "long-term" medication? Enroll in mail order today! There are two options available to you: traditional mail order or online enrollment.

Save money and time, download new Prescription Mail Order Forms. For more information on home delivery (mail order) information, please visit the Costco Mail Order Pharmacy FAQ page.

To enroll in traditional mail order services, please see the forms below.

Mail Order Form – English
Mail Order Form – Spanish 

For more information, please reach out to directly to Costco Mail Order Pharmacy at (800) 607-6861 or click here.

For instructions on how to enroll for prescriptions online with Costco Mail Order, click here.

Navitus Member Portal

This private, secure website is designed just for you. All of your pharmacy plan information is available and kept up-to-date in real time.

Easy access allows you to:

  • Manage all your prescriptions on a single dashboard
  • Compare prices at local pharmacies
  • Find your lowest prescription cost
  • Locate your pharmacy and get driving directions
  • Keep track of your health history
  • Learn more about your drugs
  • Take it all with you through the mobile app
  • And much more.

Visit https://members.navitus.com/ and use your member ID number to register. Questions? Call Navitus Customer Service at (866) 333-2757. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).

Navitus Mobile App

The mobile app provides easy, on-the-go access to your personalized health information. Once you have your member ID number, download the app to take advantage of the benefits your pharmacy plan offers. Managing your prescription medications is a key part of managing your health. Take your medication information with you wherever you are with the mobile app. Download now for iOS and Android devices. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).

For Mobile App Account Assistance Contact Customer Care, please call customer service at (844) 268-9789.

Navitus QR Code

Contact Us

For more information on your pharmacy benefits, contact Navitus Customer Service at (866) 333-2757.

Additional Forms and Exception Requests

Member Reimbursement Drug Claim Form - English (Coming Soon)
Member Reimbursement Drug Claim Form - Spanish (Coming Soon)

For Prior Authorizations, download a Texas Prior Authorization Form. For more information, contact Navitus by phone at (866) 333-2757. Physicians can contact (866) 333-2757 or fax information to (855) 668-8552.  Physicians can also go online at CoverMyMeds.com or Navitus.com.

If you disagree with a Prior Authorization decision, you have the option to appeal the decision within 180 calendar days. For Appeals, download the Navitus Appeal Request Form. For more information, contact Navitus by phone at (866) 333-2757. Physicians can contact (866) 333-2757 or fax information to (855) 668-8552.  Physicians can also go online at CoverMyMeds.com or Navitus.com.

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