2025 Quartz Formulary
Small Group Iowa, Minnesota, Wisconsin
Quartz Formulary
The formulary is the list of medications covered by Quartz through the prescription drug benefit. This page has formularies for Small Group plans offered through your employer (generally employers of 50 people or less). Use this formulary list to check your drug coverage for your if your group has not renewed coverage since 2024 (you have not had your open enrollment period).
If you are already a Quartz member the best way to ensure you are looking at the correct formulary is to go to Quartz MyChart.
For questions or to verify your plans coverage, please contact Member Services at (800) 496-7509.
Empower yourself by knowing which tier your prescriptions are in. Look up your drug name on the printable formulary and find the corresponding tier.
All pharmacy plans include coverage of preventive drugs as recommended by the United States Preventive Services Task Force (USPSTF) at $0 cost to members.
Quartz continues to offer High Deductible Health Plans (HDHPs). These plans will use the 6-tier formulary structure. Under these plans, members will pay the cost of all covered prescription drugs until the deductible is met.
Helpful resources for your pharmacy and prescription needs
Exceptions to the Formulary
The formulary is a list of medications that are covered by Quartz Medicare Advantage (HMO). If you are taking a medication that is not on the formulary, your doctor can ask for an exception to the formulary.
Exceptions include:
- The drug is not covered by the plan (Non-Formulary).
- The drug is covered, but there are restrictions on the drug. For example,
- You need to try Drug A to see if it will work before Drug B can be covered (Step Therapy), or
- There are limits on the number of tablets covered per day (Quantity Limit).
If your doctor believes you have medical reasons for an exception, he or she can help you request an exception. They may submit a Coverage Determination Request.
What to do if your drug is not on the formulary
- Change to another drug. Ask your doctor to see if another drug on the formulary might work just as well for you.
- Submit a formulary exception request. Your doctor can ask for an exception so we will cover a non-formulary drug due to medical reasons. Such reasons include: – all of the similar drugs on the formulary would not be effective for you or -they would cause side effects for you
If you are a current member and a drug you are taking will be removed from the Formulary or restricted in some way for next year, we will allow you to request an exception in advance for the next year. We will give you an answer to your request for an exception before the change takes effect.
Specialty Pharmaceuticals Program
What is a Specialty Pharmaceutical?
Specialty pharmaceuticals are a group of high-cost medicines that are used to treat chronic health problems. These therapies tend to be more complicated and more costly than others. They may require special storage, regular lab testing, and screening tests and may be given by injection or orally. To get the most benefit, regular adherence to the regimen is needed.
What is the Quartz Specialty Pharmaceutical Program?
The Specialty Pharmaceutical Program provides high-quality clinical monitoring to patients using approved medications. The goal is to help the patients stay healthy and keep coverage of these medicines affordable. The majority of drugs included in Quartz’s Specialty Pharmacy network have pharmacist-run management programs to maximize patient knowledge and outcomes from taking these medications. This may include additional follow-up from the pharmacist or partial dispensing protocols.
Specialty medications may require a Prior Authorization and must be provided by a pharmacy in the Specialty Pharmaceutical Program. You will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy. Medications included in this program are noted with an “SP.” To see if your medication is part of the program and/or requires a prior authorization, review the Quartz Formulary.
How to get your medicines from the Specialty Pharmaceutical Program
If the medication requires a Prior Authorization, have your doctor or nurse submit a Medication Prior Authorization Form for your medication to the Quartz Pharmacy Program.
Call to start the enrollment process at one of our Participating Specialty pharmacies:
- Aurora Specialty Pharmacy at (844) 820-5600
- Gundersen Health System Pharmacies at (877) 208-1096
- UW Health Pharmacy at (866) 894-3784
- UW Health Northern Illinois Pharmacy at (888) 861-0854
Answer the questions from pharmacy staff. They will also discuss delivery or pick-up. They will contact your doctor or nurse to get a copy of the prescription.
Program Disclaimers:
This program does not apply to drugs given by a doctor or nurse in a clinic, hospital, or other health care facility. This program DOES NOT apply to members covered under the State of Wisconsin Health Insurance Program, those who have Navitus for their drug benefit, or members with BadgerCare Plus. Any Wisconsin pharmacy that is in Quartz’s participating pharmacy network, and can meet the terms and conditions, can participate in the Quartz Specialty Pharmaceutical Program. Pharmacies may contact the Quartz Pharmacy Program at (888) 450-4884 for a copy of the terms and conditions, or to apply to participate.
Vaccine coverage
Coverage of select immunizations is available to you under your pharmacy benefit. Simply present your Quartz ID card to a network pharmacy. Contact your local pharmacy for information about vaccine and appointment availability. Limitations and restrictions may apply.
Examples for vaccines that can be obtained under the pharmacy benefit include:
- Covid-19
- Influenza (flu)
- Pneumococcal (pneumonia)
- Shingles (herpes zoster)
- Tetanus/Whooping Cough (Tetanus, diphtheria, pertussis; TDaP)
- Hepatitis B
- HPV (human papilloma virus)
Contact us
Quartz is here to help. That’s why we make it easy to reach us.
Call Quartz Customer Success (844) 644-3455 or message us on Quartz MyChart.