Quartz Medicare Advantage
Dual Eligible with Rx
Pharmacy Benefits
If you have any questions, you can call and speak to a Medicare expert
at (866) 491-1335 (TTY: 711).
2023 Copay Amounts
Part D vaccines are covered at no cost to you. You won’t pay more than $35 for a one-month supply of covered insulin, no matter what cost-sharing tier it’s on.
| | Retail 30-day | Retail 60-Day | Retail 90-Day | Mail Order 90-Day |
|---|---|---|---|---|
| Tier 1 (Preferred Generic) | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 2 (Generic) | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 3 (Preferred Brand) | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 4 (Non-Preferred Drug) | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 5 (Specialty) | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 6 (Vaccines) | $0 | N/A | N/A | N/A |
Initial Coverage Gap begins at: $4,660 | Catastrophic Coverage begins at: $7,400