To see which drugs need Medication Prior Authorization, check your plan's formulary.
You can also see your plan's Medication Prior Authorization List.
Does your doctor or nurse give you your medicine (through an IV, for example)?
If so, you may need an approved Prior Authorization first. Be sure to check the Medication Prior Authorization List for your plan. If the medicine is on that list, you need to get a Medication Prior Authorization.
Your clinic staff can help you.
You or your doctor can fill out a Medication Prior Authorization Request (PA Request). Or your designated representative can fill it out. You can send it in via the web, fax, mail, or telephone.
It makes the most sense to have your doctor / nurse or pharmacist fill out the PA Request for you. They will have your medical history information that is needed. That means the PA Request can be reviewed more quickly.
Once Quartz gets the Medication PA Form, we make a decision as soon as possible. However, if we don’t have all the information and have to ask questions, it can take up to 15 days.
Once a decision is made, we will send a notice to you and your doctor.
Requests will only be treated as urgent for documented clinical reasons. Otherwise the request will be processed normally.
Medication PA Requests are reviewed by pharmacy staff using criteria set by Quartz’s Pharmacy and Therapeutic (P&T) Committee. If more information is needed, Quartz will contact your doctor or nurse.
In that case, the decision and notice may take up to 15 days.
If your PA Request is approved, Quartz will cover the medication. Your copay will match the formulary and brand / generic status of the drug. You can check this by looking up the drug on your formulary.
If your Prior Authorization Request is denied, Quartz will not pay for the medication. The denial notice will include the reasons for the denial.
Note: Prior Authorization only affects whether or not a medication is covered by Quartz.
