Navitus Health Solutions

What Navitus Health Solutions does

Navitus Health Solutions, founded in 2003 and headquartered in Appleton, Wisconsin, is a full-service, URAC- and NCQA-accredited pharmacy benefit management (PBM) company serving approximately 18 million members across roughly 800 clients. The company is jointly owned by SSM Health (a Catholic not-for-profit health system) and Costco Wholesale, and operates additional offices in Madison (Wisconsin), Austin, and Scottsdale. Its customer base spans self-funded employers, labor unions, health systems, health plans, and federal and state government programs across more than 20 states, including the Navitus MedicareRx (PDP) line which has held the highest PBM-sponsored PDP EGWP Star Rating for ten consecutive years.

Navitus differentiates through a 100% pass-through pricing model in which all negotiated rebates, manufacturer discounts, and network fees are returned to clients, with no spread pricing, rebate retention, or margin from pharmacy network contracts. The company built its own single, fully redundant claims adjudication platform that processes real-time point-of-sale prescriptions across retail, mail, and specialty channels. Product lines include core PBM services (claims adjudication, formulary and utilization management, pharmacy network management, 24/7 member enablement), the Lumicera Health Services subsidiary (the nation's first cost-plus specialty pharmacy with FIFO inventory), the Archimedes majority-owned business for medical specialty drug management, and Navitus Key (formerly EpiphanyRx), a bundled solution for self-funded employers under 5,000 lives. A recent strategic addition is Lumicera Clarventa, launched March 31, 2026, targeting supply-chain transparency for pharmacies, manufacturers, and wholesalers.

Revenue is generated through disclosed administrative fees paid by plan sponsors and health plans (subscription-style, multi-year contracts), Lumicera's flat patient-management fee on top of actual drug acquisition cost for specialty dispensing, Archimedes' outcome-based managed services for medical specialty drug management (delivering 2:1 ROI), and MedicareRx PDP premiums. The go-to-market is consultative enterprise sales supported by an inside sales function for mid-market and Navitus Key accounts, plus direct distribution channels including the Costco Pharmacy network under a cost-plus pricing partnership effective January 2026. Operating geographies are domestic (United States only), and the company employs 501-1,000 associates across its four campuses.

Name

Navitus Health Solutions

Legal name

Navitus Health Solutions

Website

https://navitus.com

Company type

Private

Founded year

2003

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Navitus Health Solutions is a privately held, full-service pharmacy benefit manager serving ~18 million members across ~800 employer, health plan, union, and government clients under a 100% pass-through pricing model, with owned specialty pharmacy (Lumicera) and medical specialty management (Archimedes) subsidiaries.

Ownership category

akta.pro rank

Product category

Pharmacy Benefit Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health Care and Social Assistance (62)

SIC

Services-Health Services (8000), Hospital & Medical Service Plans (6324)

akta.pro primary industry

PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL)

akta.pro secondary industries

Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Specialty Pharmacy & Complex Therapy Management Platforms (HLACAKAG), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN), Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC) (HLADALAI)

Keywords

• Pharmacy benefit management
• Pass-through PBM services
• Specialty pharmacy solutions
• Formulary management services
• Drug trend management

Headquarters

HQ city

Appleton

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Supply Chain

Revenue model

1. Pharmacy Benefit Management Administrative Fees: Revenue generated from a simple, disclosed administrative fee charged to plan sponsors and health plans. The pass-through model means Navitus does not profit from spread pricing, drug markups, or rebate retention. Revenue is tied to service fees rather than drug cost inflation.
2. Medical Specialty Drug Management (Archimedes): Navitus assumed majority investment in Archimedes in 2024 to provide medical specialty drug management solutions. Archimedes generates revenue from analytics, technology, and clinical engagement services that help plan sponsors and health plans manage specialty drug costs across the medical benefit, delivering 2:1 ROI.
3. Specialty Pharmacy (Lumicera): Lumicera Health Services, a wholly-owned subsidiary of Navitus, operates as a cost-plus specialty pharmacy. Revenue generated through a flat patient-management fee on top of actual drug acquisition cost plus shipping. In 2024, Lumicera achieved a patient net promoter score of 85.
4. 100% Rebate Pass-through: While not a direct revenue stream, Navitus returns 100% of all negotiated rebates, discounts, and fees back to clients. The company is audited annually to verify pass-through is correct and complete. This pass-through model differentiates from traditional PBMs and drives client retention.

Pricing tiers

Go-to-market motion3 records

Distribution channels6 records

Marketing channels10 records

Core offering

Navitus Health Solutions is a full-service pharmacy benefit management (PBM) company that administers prescription drug benefits on a 100% pass-through pricing model for plan sponsors. The company delivers claims adjudication, formulary and utilization management, pharmacy network management, and member support services. It operates Lumicera Health Services as a cost-plus specialty pharmacy subsidiary and Archimedes for medical specialty drug management, and offers Medicare Part D plans under the MedicareRx (PDP) brand. Navitus serves nearly 18 million members across approximately 800 clients including employers, health plans, unions, government programs, and health systems.

Product overview

Navitus Health Solutions is a pharmacy benefit management (PBM) company operating a 100% pass-through model. Its portfolio consists of three main brands: the core Navitus PBM (claims adjudication, formulary & utilization management, pharmacy network management, and member enablement), Lumicera Health Services (the first cost-plus specialty pharmacy subsidiary providing transparent specialty drug pricing), and Archimedes (specialty drug management via majority investment). Supporting products include MedicareRx (government Part D programs), Navitus Key (formerly EpiphanyRx — bundled PBM for employers under 5,000 lives), and digital member/prescriber/plan sponsor/pharmacy portals. The company serves nearly 18 million members across approximately 800 clients.

Differentiator

Problem solved

Functional benefit

Brands

• Navitus Key: A specialized solution for employer groups under 5,000 lives - a market often underserved by traditional PBMs. Formerly known as EpiphanyRx, it provides pass-through PBM partnership value.

Products and services

• Navitus PBM Full-service pharmacy benefit management on a 100% pass-through model, returning all negotiated rebates, discounts, and fees to clients. Includes claims adjudication, formulary and utilization management, pharmacy network management, and member support services for employer groups, health plans, health systems, unions, and government programs.
• Lumicera Health Services Wholly-owned specialty pharmacy subsidiary operating as the nation's first cost-plus specialty pharmacy. Uses FIFO inventory management and charges clients actual drug acquisition cost plus a flat patient-management fee and shipping. Achieved a patient NPS of 85 in 2024.
• Archimedes Majority-owned subsidiary providing analytics, technology, and clinical engagement services for medical specialty drug management. Includes RxPostCheck retrospective claims analysis and MAP (Medically Administered Products) formulary solutions. Delivers 2:1 ROI on medical specialty management.
• Navitus Key Fully bundled PBM solution purpose-built for self-funded employer groups with 5,000 or fewer members — a market often underserved by traditional PBMs. Includes formulary management, utilization management, network, and member support packaged together.
• MedicareRx (PDP) Navitus Medicare Part D Prescription Drug Plan offering, including MAPD EGWP, Dual Eligible and Special Need Plans (D-SNP, C-SNP, I-SNP), Medicare-Medicaid Plans, PACE, and PDP EGWP. Rated 4.5 out of 5 Stars for 2026 plan year, marking the tenth consecutive year as the highest rated PBM-sponsored PDP EGWP plan.

Quantifiable outcome

• Up to 20% reduction in prescription drug costs compared to traditional PBMs
• +6 more outcomes

Named customers13 records

Segments6 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Managed Health Care Associates (MHA)coreStrategic or Co-development Partner · 16 October 2025MHA and Navitus Health Solutions announced a new agreement to protect LTC (Long-Term Care) pharmacy members from market and regulatory changes, including those from the Inflation Reduction Act. The agreement involves Medicare Part D contracts that support long-term care pharmacies with sustainable reimbursement practices and expanded patient care services. This partnership addresses regulatory challenges and ensures LTC pharmacy sustainability.
• Costco PharmacycoreChannel Partner/ Reseller/ Distributor · 5 August 2025Costco Pharmacy partnered with Navitus to implement a cost-plus pricing model for prescriptions starting January 1, 2026. The model provides transparent drug costs, leveraging Costco's significant purchasing power and offering no-cost same-day delivery through Instacart for nearby members. This partnership expands Navitus' pharmacy network and aligns with Costco's value positioning. Richard Stephens, RPh (Senior Vice President of Pharmacy, Costco) and Brad Hanna, PharmD (Vice President of Pharmacy Operations, Costco) serve on Navitus' Board of Directors, indicating a deep strategic relationship.
• ArchimedescoreStrategic or Co-development Partner · 1 January 2024Navitus Health Solutions assumed a majority investment in Archimedes in 2024. Archimedes is the industry leader in specialty drug management, providing analytics, technology, and service solutions for employers, health plans, and health systems. The partnership brings best-in-class technology and comprehensive solutions that manage the full spectrum of specialty drug costs across pharmacy and medical benefits, including solutions like RxPostCheck and MAP Formulary. Heather Sundar, PharmD serves as President & CEO of Archimedes.
• EpiphanyRxcoreStrategic or Co-development Partner · 19 July 2021Navitus expanded through the acquisition of EpiphanyRx (announced July 2021). EpiphanyRx is a PBM solution that was subsequently rebranded as Navitus Key — the company's specialized solution for employer groups under 5,000 lives. Covington Associates advised on the sale of EpiphanyRx to Navitus.
• Quality Drug Clinical CarecoreStrategic or Co-development Partner · 19 July 2021Navitus expanded through the acquisition of Quality Drug Clinical Care (announced July 2021). This acquisition contributed to Navitus' capabilities and market expansion as part of its growth strategy.
• Hello HeartminorStrategic or Co-development PartnerNavitus expanded its digital health offerings through a partnership with Hello Heart, a digital health platform. This partnership broadens Navitus' member wellness offerings beyond medication management to address broader physical and financial well-being of members.
• Lumicera Health ServicescoreOEM/ Whitelabel/ Licensing PartnerLumicera Health Services is a wholly-owned subsidiary of Navitus Health Solutions. Founded as the nation's first cost-plus specialty pharmacy, Lumicera operates with full transparency — charging clients actual drug acquisition cost plus a flat patient-management fee and shipping. Navitus acquired Lumicera to provide a unique specialty pharmacy option for clients. Lumicera achieved an NPS of 85 in 2024. Ben Heiser serves as CEO of Lumicera and Sharon Faust, PharmD, CSP oversees Lumicera as Chief Pharmacy Officer of Navitus.

Scale indicators9 records

Recent moves9 records

Expansion highlights6 records

Broad incumbents

• Express Scripts: PBM owned by Cigna Group; one of the largest PBMs in the U.S. Directly competes with Navitus for large employer and health plan PBM contracts, with substantial rebate aggregation capabilities.
• Walgreens Boots Alliance (VillageMD/AllianceRx): Major U.S. pharmacy operator with affiliated specialty pharmacy (AllianceRx) and primary care assets, increasingly competing in PBM-adjacent services. Relevant broad incumbent comparison given specialty pharmacy and retail distribution overlap with Navitus/Lumicera.
• Optum Rx: Pharmacy benefit management arm of UnitedHealth Group, the largest PBM in the U.S. by prescription volume. Direct competitor to Navitus in employer and health plan PBM contracts, with scale advantages and integrated payer assets.
• CVS Caremark: PBM division of CVS Health, among the Big 3 PBMs. Competes with Navitus across commercial employer, health plan, and government programs, with significantly larger scale and vertical integration into retail pharmacy.

Direct peers

• Prime Therapeutics: Independent PBM owned by a consortium of Blue Cross Blue Shield plans, serving health plan clients nationally. Comparable to Navitus as a non-vertically-integrated PBM with health plan/government program focus.
• MedImpact Healthcare Systems: Independent, non-profit-affiliated PBM offering transparent pharmacy benefit management to health plans, employers, and government programs. Comparable to Navitus as a non-Big-3 PBM with transparent model positioning.
• Elixir (Roper Technologies / formerly EnvisionRx): PBM and pharmacy services company serving health plans, employers, and government programs. Comparable to Navitus in offering integrated PBM and specialty pharmacy capabilities with a transparent positioning.
• RxBenefits: PBM partner focused on self-funded employers, particularly in the mid-market segment. Comparable to Navitus Key's positioning as a transparent PBM solution for smaller employer groups underserved by traditional PBMs.
• SmithRx: Transparent PBM focused on self-funded employers with modern technology platform and pass-through pricing. Closely comparable to Navitus in mission and target customer base, with similar cost-plus philosophy.
• Capital Rx: Independent, fully transparent PBM operating on a technology-driven, pass-through model. Closest direct competitor to Navitus in the transparent PBM category serving employers, unions, and TPAs.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/user/navitushealth
• Facebookfacebook.com/Navitus-Health-Solutions-323034394483172
• LinkedInlinkedin.com/company/navitus-health-solutions
• Xx.com/navituspbm

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles16 records

Subsidiaries3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Navitus Health Solutions