The Prescription Drug Benefit Brochure provides detailed information about Quartz’s pharmacy benefits.
You can determine the copay level (tier) for your patient’s medications by reviewing Quartz’s Drug Formulary. The formulary lists medications by drug class according to the copay tier.
Quartz populates formulary information with the Surescripts hub for use in e-prescribing applications. Surescripts will display the copay tier of the medication.
Certain medications require prior authorization before coverage is provided.
Quartz’s Specialty Pharmaceutical Program provides high-quality clinical monitoring for patients using specialty medications while helping keep coverage of these products affordable.
The Quartz Drug Formulary includes the designation of “SP” if the medication is in the Specialty Pharmaceuticals program. Call UW Health Pharmacy at (866) 894-3784 or Gundersen Health System Pharmacies at (877) 208-1096 with questions or to help enroll a patient in the Specialty Pharmaceuticals program.
Pharmaceuticals provide much-needed innovative therapies for patients. However, they also have a significant impact on health care costs. When those drugs are administered in a health care setting, the price markup ranges from 2-10 times the facility’s cost. And costs continue to rise, often creating a significant financial burden for patients who need these drugs. Quartz has a similar burden for our share of the costs.
At Quartz, we believe in helping our members get the care they need at the right cost. That’s why we are implementing changes in our reimbursement practices for drugs given in the doctor’s office or other health care settings.
Quartz is offering providers three options, in order from preferred to least preferred:
The following drugs are included initially in the program:
The list will expand as other drugs are identified in the future that generate additional savings through this program.
Before program implementation, we will send your providers or PA coordination department a list of current Quartz members receiving designated medications at your facility who will need to obtain those medications from the specialty pharmacy.
Future prior authorization approvals for designated medications will include details for procuring the drugs, including through Accredo if that is the case. Included drugs are noted in the answer to the question, "What drugs are affected?" above. Included drugs that also require prior authorization are indicated by an asterisk in our Medication Prior Authorization List.