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Benefits & Services Prescription Benefits

New Prescription Benefits Through Navitus

You will have a new pharmacy network starting January 1, 2021. Don't forget to show your new benefits ID card to your pharmacy before your next refill or prescription. If you had a prescription regularly filled at Walgreens, don't forget to transfer your prescription to an in-network pharmacy before January 1, 2021. Watch the video for more details. If you need help, Navitus Customer Care will be pleased to help you at 855-673-6504.

The prescription drug plan included with your TML Health medical benefits is managed by Navitus, which offers many participating pharmacies and a mail order program, so you can get your prescriptions close to home.

Once your prescription benefits with Navitus begin, log into the Navitus web portal at navitus.com to see what drugs are covered, or find an in-network pharmacy.

You can also receive your medications by mail order through Navitus's partnership with CostCo.

Latest Information

Latest Information Title 1(Updated 09/11/2020)

The CDC has issued new guidelines for when patients with COVID-19 being treated at home may end self-isolation. When:

  1. at least 10 days have passed since you started having symptoms
  2. and you've had no fever for at least 24 hours without using medication for fever
  3. and your other symptoms have improved
you may stop self-isolating under CDC guidelines. A second test is usually not necessary to confirm it is safe to end self-isolation.

Some patients who have severe cases of COVID-19 may be contagious even after 10 days and need to continue self-isolating. For more information, including how to self-isolate if you have no symptoms but have tested positive for COVID-19, see the CDC's website.

What to do if you don’t have your prescription benefits card yet

To fill a prescription, you can show the pharmacy either your updated TML Health ID card (with the Navitus logo) or your Navitus ID card. Both cards were mailed to your address on file in mid-December. If you haven’t received yours yet, and you need to get a prescription filled, you have several options:
  • Log onto your member portal account at tmlhealthbenefits.org and click “Retrieve ID Card” to download and print a copy of your ID card. You can use this copy at the pharmacy.
  • Call Navitus Customer Care at (855) 673-6504 and they can help you get the ID information, download the Navitus app, and also work with the pharmacist to get your prescription claim processed.
  • Have your pharmacy call Navitus to obtain your member information.
  • Call TML Health Customer Care at (800) 282-5385 and we can assist you.
Also, remember that as of January 1, 2021, Walgreens pharmacy is no longer in network. If you have prescriptions at Walgreens, you will need to transfer them to another pharmacy. Call Navitus Customer Care at (855) 673-6504 or log in at Navitus.com for assistance locating a nearby pharmacy that is in-network.

FAQs

1. Is my pharmacy in-network?

We use a Narrow Network with nearly 3,000 pharmacies right here in Texas, including, but not limited to:

  • HEB
  • Walmart
  • CVS
  • Sam's Club
  • and many independently owned local pharmacies.

As our Narrow Network is designed to provide value and cost savings to keep rates stable for our members, our network does not include Walgreens.

If you are with a self-funded group, please check your employer’s network coverage, as it may vary.

2. Where can I go to find a list of participating Navitus pharmacies in my area?

You can find pharmacy information either through the Navitus Member Portal at navitus.com or the Navitus App.

3. How can I transfer a current prescription to an in-network pharmacy with Navitus?

If you are currently filling prescriptions at a pharmacy that will not be part of the Navitus network, the easiest way to transfer a prescription is to call your current pharmacy and ask them to transfer the prescription to a pharmacy that is in-network with Navitus.

4. Where can I find the most up to date Navitus formulary (list of covered medications)?

After you receive your new ID card, you can find information on what drugs are covered by your plan by logging into the Navitus Member Portal or the Navitus App and clicking the link that reads "Formulary."

5. Will I get an ID card from TML Health with Navitus information?

Yes. You will get two new ID cards: one from TML Health with the Navitus information on it; and another from Navitus. You may choose to use either one, or both, of the cards for your prescription benefits. As soon as you receive your card, please present it to your pharmacy so that they can update your records accordingly. This will help ensure that there will be no interruptions when you are ready to pick up your next prescription fill.

6. Does Navitus have a member portal?

Yes! On or after the date your plan starts, you can access the member portal this way:

  1. Go to the Navitus website, Navitus.com
  2. Select Portal Login
  3. Click Member Portal
  4. Click Click here for new registrations to register your account

7. If I have questions about my drug costs, prior authorization, step therapy, specialty drugs, or other questions, who should I call?

You can call Navitus Customer Care. You can find the phone number on your new ID Card, and in your welcome letter and introductory communications.

8. I went to pick up my prescription and my cost is higher than what it was last month for the same drug. Why?

There can be many reasons for this, but one of the most common reasons with new pharmacy benefits, is that the pharmacy is still billing your old pharmacy benefits manager instead of the new one. Please check with the pharmacy and confirm that they billed Navitus. If they did, and your cost is still higher, please call Navitus Customer Care at the number on your new ID Card.