Pharmacy Benefit FAQ

Navitus Health Solutions is a pharmacy benefit manager contracted to provide cost-effective prescription drug benefits for Memorial Hermann Health Plan members and to improve member health and minimize their out-of-pocket costs.

A pharmacy benefit manager (PBM) processes and pays prescription drug claims for its members. It contracts with pharmacies and builds and maintains drug formularies. A PBM also negotiates discounts and rebates with drug manufacturers.

Navitus Health Solutions is our pharmacy benefit manager and manages the pharmacy benefits on behalf of Memorial Hermann Health Plan and its members.

Your health plan will provide the plan benefit information to Navitus Health Solutions (Navitus) automatically. You will also be issued a member ID card if you are new to our plan. Please provide this card to your pharmacy to process new prescriptions under your pharmacy benefit.

Helpful Advice – Remember to present the new member ID card to your pharmacy so that they can access your benefits. If you do not have the new member ID card handy, please call the Memorial Hermann customer service at (855) 645-8448 to obtain your pharmacy claim processing information, which can be presented to your pharmacist to process the pharmacy claim until you have received your new member ID card.

You can find a participating retail pharmacy near you by calling Navitus Customer Services toll-free at (866) 333-2757.

Yes, please contact (800) 607-6861 or visit the website https://www.costco.com for more information on how to sign up for home delivery. After you enroll a prescription in mail order, Costco Mail Order will send your prescription or prescription refill after verifying your credit/debit card information. For more information, please scroll below to the section, “Costco Mail Order”.

To determine the most up-to-date formulary status of your medication, please visit your Navitus member portal website or call Navitus member services at (866) 333-2757 for more information about your drug benefits.

• If your provider wishes for you to continue receiving the medication that is not covered or excluded, please have your provider request an exception request process through Navitus.
 
• For more information about the Navitus formulary, you may call Navitus Customer Service toll-free at (866) 333-2757 or ask your provider to contact Navitus toll-free at (866) 333-2757 to start the exception request process.

For the most up-to-date formulary status of your medication, please visit the online formulary for employer plans. You may also visit Navitus member portal website or call member services at the number listed on your ID card. Members can get more information from their personalized online member portal by creating an account at https://members.navitus.com.

Navitus Customer Care is available 24 hours a day, 7 days a week (closed Thanksgiving and Christmas Day). Please contact them at: (866) 333-2757.

Memorial Hermann Specialty Pharmacy and Lumicera Specialty Pharmacy are just two specialty pharmacy vendors that Memorial Hermann Health Plan is using. Members can use any in-network specialty pharmacy vendor of their choice.

To learn more about Memorial Hermann Specialty Pharmacy. Please visit Specialty Pharmacy and by reading their Frequently Asked Questions.

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.

Memorial Hermann Health Plan and Navitus Health Solutions have partnered with Costco Mail Order Pharmacy to provide your mail order prescription benefits.

No. You don't need to be a Costco Member to use Costco Mail Order Pharmacy.

You can register via mail or phone or via online. Below are the two methods to register for home delivery service with Costco Mail Order Pharmacy.

Option 1: Traditional Mail Order Process - If you register for Costco using mail or phone process, it is called the Traditional Mail Order. Traditional Mail Order requires you to order all your prescriptions via mail or phone. You must complete the included patient profile form and submit it to Costco Mail Order Pharmacy. Traditional Mail Order also accepts personal checks and Electronic Funds Transfer as forms of payment.

Option 2: Online Ordering service requires you to order all your new prescriptions online at www.costco.com. You should create an online account. Please remember that each individual receiving medications must have their own unique email address in order to create an online account. All communication between you and the pharmacy will be done via email.

You can contact Costco Mail Order Pharmacy at (800) 607-6861. Please scroll down to download the Traditional Enrollment Form under “Additional Information” section below.

To register for an online account, you need to go to Costco.com and create an account.

Please Note: A Costco Membership is not required, you do not need to enter a membership number. Creation of an online login just requires an email address and a password. If you already have a Costco account, simply click login and log into your account.

Please use the following instructions to complete a mail order profile setup after creating your online login account or logging into your existing Costco account:

Step 1: After creating the account, hover over the Pharmacy link at the top, middle of the page.
Step 2: Click on the “Mail Order” option..
Step 3: From there, over on the right, click on Fill New Prescriptions - this will take you to your profile page where you can set up your personal information, drug allergies, insurance, payment, and shipping information. You can enter all the information..
Step 4: Please click and agree to the Terms of Service for Costco Mail Order..
Step 5: Finally, you click "Complete Profile," your registration for Pharmacy is complete, and you can start using the service immediately.

Step 1: After creating the account, hover over the Pharmacy link at the top, middle of the page..
Step 2: Click on the “Mail Order” option.
Step 3: From there, over on the right, click on Fill New Prescriptions – (this will direct you to Sign In).

Your doctor can reach out to Costco Mail Order Pharmacy directly or use electronic prescribing software (e-scripts) to select Costco Mail Order Pharmacy and to send prescriptions. Providers and Members can also call Costco Mail Order Pharmacy at (800) 607-6861 for any help with processing their prescription. For more information, please read the section titled “How do I order a new prescription using the Online Ordering service?” in the Costco Mail Order Pharmacy brochure. For the Costco Mail Order Pharmacy brochure in Spanish “¿Cómo pido una receta nueva usando el servicio de Pedidos en Línea?.”

Members need to register at Costco.com before they can fill or request refills for mail order prescriptions. Note: You do not need to be a Costco Member to use Costco Mail Order Pharmacy. Information from the new member ID card is needed to register and members can register by phone, mail or online. Home delivery forms and FAQs are available by scrolling down to the "Additional Information" section below.

Note: You should expect to receive your mail order prescriptions 14 days after Costco Mail Order Pharmacy receives your refill request. Make sure you have an adequate supply of your medication on hand to allow for this time period.

Yes, please reach out to Costco Mail Order Pharmacy, they allow members to enroll in the automatic refill program. Please be aware that prescriptions on auto-refill will still require your consent before we can fill them. A valid email address and payment method must be on file with Costco Mail Order Pharmacy in order to use the auto-refill system. To enroll your prescription in the auto-refill program, you can either enable auto-refill for each prescription yourself on the Refill Prescriptions page on the online Costco account, or Contact Costco Mail Order Pharmacy via phone at (800) 607-6861. Please note auto-refills will not be available for controlled substances and refrigerated medications.