Navitus Health Solutions

Navitus Health Solutions

Transparent PBM pass-through rebates for plans

Overview

Navitus Health Solutions is a pharmacy benefits manager that offers transparent pricing by passing 100% of negotiated rebates and discounts to its health-plan clients. It runs a spend-management clinical model designed to control drug costs from the outset while supporting member health, delivering both immediate value and long-term savings as drug spend trends are managed over time. The company markets its services through its portfolio brands—Navitus, Lumicera, and Archimedes—and serves over 18 million members across 800 clients, including public and private employers, unions, health plans, and health systems. It is owned by SSM Health and Costco Wholesale Corporation. Unlike traditional PBMs with opaque pricing, Navitus emphasizes transparency and direct savings for plan sponsors. The overarching goal is to reduce prescription drug costs for plans while improving member health outcomes.

About Navitus Health Solutions

Simplify's Rating
Why Navitus Health Solutions is rated
B-
Rated B on Competitive Edge
Rated B on Growth Potential
Rated C on Differentiation

Industries

Company Size

1,001-5,000

Company Stage

N/A

Total Funding

N/A

Headquarters

Appleton, Wisconsin

Founded

2003

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Simplify's Take

What believers are saying

  • CommunityCare switched to Navitus on January 1, 2026, expanding regional account momentum.
  • Navitus launched Costco cost-plus access for clients beginning January 1, 2026.
  • The 2026 Drug Trend Report gave clients fresh evidence for savings selling.

What critics are saying

  • Arkansas Act 624 litigation keeps pharmacy-ownership restrictions alive through 2026.
  • PBM transparency laws in the Consolidated Appropriations Act of 2026 compress pricing power.
  • If employers standardize transparent PBMs in 2026, Navitus loses differentiation and pricing leverage.

What makes Navitus Health Solutions unique

  • Navitus still leads with 100% pass-through pricing and flat administration fees.
  • SSM Health and Costco ownership gives payer credibility and pharmacy purchasing leverage.
  • Navitus MedicareRx held a 4.5 CMS Star Rating for 2026, tenth straight year.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Paid Vacation

Paid Holidays

Parental Leave

401(k) Company Match

Adoption Assistance Program

Flexible Spending Account

Tuition Reimbursement

Professional Certification Support

Employee Referral Bonus

Company News

Fox Business
Aug 13th, 2026
Nine major PBMs to display TrumpRx prescription drug prices from 2027

Nine pharmacy benefit managers will integrate TrumpRx prescription drug pricing into their benefit tools, effective 1 January 2027. The Pharmaceutical Care Management Association and participating PBMs—including CVS Health, Express Scripts, Humana, and OptumRx—will display cash prices from TrumpRx alongside plan coverage costs. The agreement covers commercial, Medicare, and Medicaid plans. Patients will see TrumpRx prices for all listed drugs, whether through presidential deals or standard pricing. CMS Administrator Dr Mehmet Oz said the commitment will help patients compare prices and find better deals. PCMA CEO David Marin stated the transparency will allow consumers to make better-informed choices about prescription drug costs. Some PBMs will use Real Time Benefit Tools to display pricing comparisons, whilst others may employ different methods.

Business Wire
Mar 31st, 2026
Lumicera Health Services launches Clarventa.

Lumicera Health Services launches Clarventa. New company will focus on transforming drug purchasing and supply chain services MADISON, Wis.-(BUSINESS WIRE)-Lumicera Health Services today announced the launch of Clarventa, a new company created to address one of the most persistent drivers of rising prescription drug costs: the complex and opaque pharmaceutical supply chain. Clarventa will focus on bringing greater transparency, efficiency and sustainability to drug purchasing and supply chain services across the pharmacy ecosystem. By creating clearer pathways to access and more predictable purchasing models, Clarventa will help market participants operate with greater confidence in what has become an increasingly complex environment. "Clarventa is a natural extension of Lumicera's mission to bring clarity and fairness to how medications are priced and delivered," Lumicera CEO Ben Heiser said. "We've proven that transparent, cost-plus models work in specialty pharmacy. With Clarventa, we're applying those same principles to drug purchasing and the supply chain - areas where lack of visibility continues to drive unnecessary cost and complexity for pharmacies, manufacturers and, ultimately, patients." Clarventa and Lumicera are part of the Navitus Health Solutions family of companies, united by a shared commitment to transparent, patient-focused health care. For nearly 25 years, Navitus Health Solutions has operated as an industry pioneer, challenging conventional models, insisting on clarity and delivering innovative, clinically based solutions that lower costs for members, pan sponsors and health plans. Navitus founded the first pharmacy benefit manager (PBM) to operate with full transparency and 100% pass-through pricing, rejecting hidden markups and refusing to retain manufacturer rebates. This approach fundamentally challenged traditional PBM practices by aligning incentives with plan sponsors and members rather than drug price inflation. The same philosophy later extended to specialty pharmacy with the launch of Lumicera, the industry's first cost-plus specialty pharmacy. Lumicera charges only the actual acquisition cost of medication plus a clearly defined patient management fee, providing clients and members with unprecedented insight into specialty drug costs while maintaining high-touch clinical care. In 2023, Navitus strengthened its clinical and analytical capabilities in specialty drug management with the acquisition of Archimedes, deepening the organization's ability to provide oversight, analytics and program design in one of the most complex and expensive areas of health care. Clarventa builds on this foundation by addressing two other significant sources of cost and complexity: drug purchasing and the pharmaceutical supply chain itself: * For pharmacies, Clarventa increases access and purchasing power, creating sustainable contracting models. * For manufacturers and wholesalers, Clarventa enables access through streamlined contracting, producing transparent agreements with clearer data flows. * For the industry, these improvements align with growing state and federal efforts to promote point-of-sale affordability for health care consumers and consistency in pharmacy reimbursement. "Pharmacies, manufacturers and wholesalers all play critical roles in patient access, yet too often the system creates friction instead of alignment," Navitus Health Solutions CEO David Fields said. "Clarventa reduces that friction by bringing clarity to how drugs are priced and purchased, while supporting affordability and fairness. As our industry continues to evolve, Clarventa is an important step in advancing transparency across the drug supply chain." About Lumicera Health Services: Lumicera Health Services, a leading specialty pharmacy solutions provider, is a wholly owned subsidiary of Navitus Health Solutions, which is owned by SSM Health and Costco Wholesale Corp. Founded in 2014, Lumicera is committed to improving specialty pharmacy care, one patient at a time, through educational, clinical, financial and service excellence. Lumicera brings clinicians closer to patients and drives positive outcomes through innovative practices and strategic partnerships. For more information, please visit lumicera.com. About Navitus Health Solutions Navitus Health Solutions is a pioneering pharmacy solutions provider that first launched a transparent pharmacy benefit manager (PBM) to pass through 100% of negotiated drug rebates and discounts to health plans and plan sponsors. The Navitus PBM is an alternative to traditional PBMs, which divert rebates and discounts for profit. Navitus leads the way in driving meaningful cost savings to help make medications more affordable. Now, nearly 25 years later, the organization delivers a range of solutions through portfolio brands including Navitus, Lumicera Health Services, Archimedes and Clarventa. Owned by SSM Health and Costco Wholesale Corp., Navitus Health Solutions serves more than 18 million lives across 800 clients including employers, unions, government plans, payers and health systems. For more information, please visit navitus.com.

CommunityCare
Dec 31st, 2025
Pharmacy Benefit Manager Change 2026

Pharmacy benefit manager change 2026. Beginning January 1, 2026, CommunityCare will partner with Navitus Health Solutions as its new pharmacy benefit manager (PBM). * More value with your prescription drug benefits. * More access to lower prescription drug costs. * Strong clinical support to ensure safe, effective use of medications. CommunityCare HMO, Inc. is working closely with Navitus to make this transition as smooth as possible for its members and will provide support for next steps. Its top priority remains making your medications affordable and accessible.

PR Newswire
Oct 16th, 2025
MHA and Navitus Health Solutions Agreement Strengthens and Protects Long-Term Care Pharmacies Amid Industry Change

MHA and Navitus Health Solutions agreement strengthens and protects Long-Term Care pharmacies amid industry change. News provided by. PARSIPPANY, N.J., Oct. 16, 2025 /PRNewswire/ - Managed Health Care Associates, Inc. (MHA), the nation's leading post-acute group purchasing organization (GPO) and pharmacy services administrative organization (PSAO), and the first Medicare Part D Reimbursement Network in the Long-Term Care (LTC) Pharmacy market, today announces a new agreement with Navitus Health Solutions, a pharmacy solutions provider that serves over eighteen million lives. This agreement includes both an active Commercial contract and a Medicare Part D contract that, for the first time, explicitly accounts for and protects MHA's LTC pharmacy members from market events such as those resulting from the Inflation Reduction Act (IRA). MHA successfully worked with Navitus to provide LTC members appropriate dispensing fees for Medicare Part D drugs included in the Drug Price Negotiation Program and reimbursed through Maximum Fair Price (MFP) methodology. The partnership also recognizes critical industry trends, such as the increasing demand for long-term care pharmacy services provided to patients residing in their homes. "This agreement is grounded in innovation and a clear commitment to protecting LTC pharmacies," said Crystal Riggs, Vice President of Network Solutions at MHA. "By proactively demonstrating the positive health outcomes our pharmacies achieve for beneficiaries while also addressing the unique challenges they face, from regulatory shifts to market pressures, we were effectively able to partner with Navitus to provide a vital layer of protection and stability. That foundation allows our members to focus on what matters most: delivering exceptional care and helping people age with grace." This collaboration reflects MHA's commitment to empower its members to thrive in a shifting healthcare environment. Together, MHA and Navitus will help pharmacies achieve positive health outcomes while strengthening the stability of their businesses by: * Supporting LTC pharmacies with sustainable Medicare Part D contract structures that protect against regulatory and market volatility, ensuring continuity of care. * Providing access to robust retail networks that enhance reach and foster new growth opportunities for pharmacies. * Creating safeguards that deliver financial and operational stability for LTC pharmacies in light of ongoing legislative changes, including the Inflation Reduction Act. * Recognizing and enabling the expansion of patient-centered care in all settings, including services for patients residing in their homes. This agreement underscores MHA's mission of helping people age with grace, a mission carried forward by its LTC pharmacy members who achieve measurable, positive health outcomes every day through demonstrated improvement in medication adherence. Navitus' service commitment - to help human beings get the care they need at a price they can afford - further strengthens this shared vision for the future of long-term care. Managed Health Care Associates, Inc. (MHA) is a leading health care services and software company that offers a growing portfolio of services and solutions to support the diverse and complex needs of the alternate site health care provider. MHA provides expertise in Group Purchasing, Managed Care and Payor Contracting, Reimbursement Management, Specialty Pharmacy Solutions, Pharmaceutical Data Analytics, Consultant Pharmacy Software and Legislative Advocacy. Through the delivery of innovative health care services and solutions, MHA helps Members increase operational efficiency, maximize business growth, and provide optimum care for their patients. For more information, visit www.mhainc.com. Navitus Health Solutions Navitus Health Solutions is a pioneering pharmacy solutions provider that first launched a transparent pharmacy benefit manager (PBM) to pass through 100% of negotiated drug rebates and discounts to health plans and plan sponsors. The Navitus PBM is an alternative to traditional PBMs which divert rebates and discounts for profit. It leads the way in driving meaningful cost savings to help make medications more affordable. More than 20 years after its founding, the Navitus Health Solutions organization delivers a range of services through portfolio brands including Navitus, Lumicera, and Archimedes. Owned by SSM Health and Costco Wholesale Corporation, the company serves over 18 million members across 800 clients, including public and private sector employers, unions, health plans, and health systems. For more information, please visit www.navitus.com

socPub
Sep 12th, 2025
Navitus Partners with Corporate Wellbeing Platform, Grokker, to Expand Whole-Person Health Resources

MADISON, Wis. - September 10, 2025 - Navitus, the nation's first and largest transparent, pass-through pharmacy benefit manager (PBM), today announced a partnership with Grokker, an award-winning employee wellbeing engagement solution that empowers users to live healthier, more fulfilling lives.

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