Your pharmacy benefits and resources
Find the pharmacy information you need to understand your prescription drug benefits, check medication coverage, explore cost-saving options, and get answers to common pharmacy questions.
Check if a medication is covered
Your plan formulary lists prescription drugs covered by your Quartz plan. Find your plan’s formulary.
Not seeing your medication in the formulary? You may need a prior authorization.
Understand your medication costs
Estimate what your medication may cost through the pharmacy benefits tool in Quartz MyChart or get in touch with our Customer Success team at (800) 362-3310.
Get your medications
Get your prescriptions the way that works best for you. You can find a nearby pharmacy or learn about convenient mail delivery options.
Find a plan’s drug list
Are you a current Quartz member?
To make sure you’re viewing details for your specific plan, visit the pharmacy benefits page in Quartz MyChart or use our formulary look-up tool.
Are you a provider or prospective Quartz member?
Enter plan information to view covered medications and prescription drug coverage details.
Understanding medication costs
What you pay for a medication depends on your plan and the drug’s tier. The formulary can help you find a medication’s tier and estimate your costs. Find your plan’s formulary.
Key pharmacy coverage terms
- Tier: a category used to group medications on your drug formulary. The tier assigned to a medication helps determine how much you pay for it.
- Deductible: the amount you pay for covered health care services and prescription drugs before your health plan starts paying its share.
- Copay: a fixed amount you pay for a covered prescription drug. The amount you pay is based on the medication’s tier.
- Coinsurance: a percentage of the cost of a covered medication that you pay. Your health plan pays the remaining portion.
- Out-of-pocket limit: the most you will pay for covered health care services and prescription drugs during a coverage period, which is typically 12 months.
Want to see how close you are to meeting your out-of-pocket limit? Sign in to Quartz MyChart to view your current progress.
Get your prescription your way
Choose the option that works best for you. Pick up your medication at a local pharmacy or have eligible prescriptions delivered to your home.
Pick up at a local pharmacy
Find an in-network pharmacy near you and get your prescription at a location that’s convenient for you.
Get your prescriptions by mail to your home
You can have eligible medications delivered to your home through a mail delivery pharmacy. This may be a convenient option for medications you take regularly.
Specialty medications and prior authorizations
Some medications have special coverage requirements. You can check your formulary to see whether a medication needs prior authorization or must be filled through a specialty pharmacy.
Exceptions to the formulary and prior authorization
Prior authorization is a process where Quartz works with your doctors to review certain medical services or prescriptions before they are provided. Quartz works closely with your doctors to minimize prior authorizations. Because we are owned by doctors, we are in a unique position to reduce the need for prior authorizations for in-network services. Learn more.
If your medication is not covered, you can ask your doctor whether another covered medication may work for you. If there is no suitable alternative, your doctor can request a formulary exception by submitting a prior authorization request.
When an exception may be needed
- A medication is not on the formulary and no suitable alternative is available
- A medication is covered but has limits, such as a step-therapy requirement or quantity limit
Specialty pharmacy
Specialty medications treat certain complex or ongoing health conditions and may require special handling or monitoring. Specialty medications are identified with an SP designation in your formulary and may need to be filled through the Quartz Specialty Pharmacy Network. Some medications may also require prior authorization. Review your formulary and pharmacy resources for details.
Are you a Medicare Advantage member?
Specialty medications are listed in your Medicare Advantage formulary as Tier 5 drugs. Some medications may require prior authorization, step therapy, or other coverage requirements. Review your formulary and pharmacy resources for plan-specific details.
Frequently asked questions
What is a formulary?
The drug formulary is a list of safe, effective, and cost-effective drugs that are eligible for coverage. Not all prescription drugs are covered, so make sure to check the formulary when you receive a prescription.
What is the best way to understand my drug coverage?
For the most accurate information, Quartz members with a Quartz MyChart account can access QuartzRx and view all your pharmacy benefit details through your Quartz MyChart account. This will be the best option for members on a Commercial, Individual and Family, or Quartz Medicare Advantage (HMO) plan. Just visit QuartzMyChart.com, sign in to your account and click “Pharmacy Benefits” under “Menu” to access the QuartzRx member portal. The first time you log in, you’ll see a HealthSafe ID screen where you will set up your QuartzRx account using your member ID. You can find this on your ID card. After you create your account, you’ll be automatically signed in to QuartzRx via MyChart.
QuartzAlign members can visit QuartzAlign.com/members and sign in to your MyCreateHealth Account for more information. From there click Pharmacy Benefit Information to be directed to the QuartzRx member portal. You’ll see a HealthSafe ID screen where you will set up your QuartzRx account using your Quartz Align member ID. You can find this on your ID card.
If you are unsure what plan you have or will have, please contact Quartz Customer Success to ensure you access the most correct information.
What is the difference between generic and brand-name medications?
A generic medication often has the same active ingredient as a brand-name medication and works the same way. A generic equivalent is usually less expensive than the brand name drug.
A generic equivalent:
- Has the identical amount of the same active ingredient in the same dosage
- Has the same route of administration (if one is a tablet, the equivalent is also a tablet)
- Is expected to have the same clinical effects
- Is expected to be just as safe
The United States Federal Food and Drug Administration (FDA) decides which drugs are equivalent to each other.
According to the FDA, generic medications must meet the same standards for purity, strength, and quality as brand name drugs. Generic drugs must be approved by the FDA before they can be sold.
Generic drugs may look different from the brand name drug. Sometimes the FDA requires a generic drug to look different than a brand name drug. For example, the tablet color, shape, or size might be different.
Where can I view my pharmacy network?
You can view your plan’s network, find a local pharmacy, and confirm that your current pharmacy is in-network using the Pharmacy Network tool at www.QuartzBenefits.com/findapharmacy. To view pharmacies in our Medicare Advantage pharmacy network, use the tool at www.QuartzBenefits.com/MAfindapharmacy.
What is a prior authorization?
Prior authorization is a process where Quartz works with your doctors to review certain medical services or prescriptions before they are provided. A prior authorization ensures that medical services, procedures, or medications are covered under your Quartz plan and medically necessary for your condition.
Quartz works closely with your doctors to minimize prior authorizations. Because we are owned by doctors, we are in a unique position to reduce the need for prior authorizations for in-network services. Learn more.
Do all Quartz health plans have drug coverage?
No, not all Quartz Health Plans include drug coverage. If you are unsure about your plan, please contact Customer Success.
What is QuartzRx?
QuartzRx is the digital pharmacy benefit tool that is available to members with a Quartz plan that includes drug coverage. Eligible members can access both the QuartzRx member portal and QuartzRx mobile app to easily manage their medications.
Where can I drop off unused medications?
To find a drop-off location, use the U.S. Department of Justice’s search tool. Simply enter your ZIP code or city and state to find a location near you.
*Not all Quartz Health Plans have drug coverage. If you are unsure, please contact Customer Success at (800) 362-3310.
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