2022 Part D Prescription Drug Coverage
Available with Quartz Medicare Advantage (HMO) Code D, Value D, and Elite D plans.
| 30-day | 30-day | Retail 60-Day | 90-Day | Mail Order 90-Day |
|---|---|---|---|---|
| Yearly Deductible | $150 Tiers 3-5 | $150 Tiers 3-5 | $150 Tiers 3-5 | $150 Tiers 3-5 |
| Tier 1 (Preferred Generic) | $0 | $0 | $0 | $0 |
| Tier 2 (Generic) | $8 | $16 | $24 | $20 |
| Tier 3 (Preferred Brand) | $47 $35 for select insulins | $94 $70 for select insulins | $141 $105 for select insulins | $118 $87 for select insulins |
| Tier 4 (Non-Preferred Drug) | 35% of cost | 35% of cost | 35% of cost | 35% of cost |
| Tier 5 (Specialty) | 30% of cost | N/A | N/A | N/A |
| Tier 6 (Vaccines) | $0 | $0 | $0 | $0 |
2021 Part D Prescription Drug Coverage
Available with Quartz Medicare Advantage (HMO) Core D, Value D, and Elite D plans.
| 30-day | 30-day | Retail 60-Day | 90-Day | Mail Order 90-Day |
|---|---|---|---|---|
| Yearly Deductible | $150 T3-T5 | $150 T3-T5 | $150 T3-T5 | $150 T3-T5 |
| Tier 1 (Preferred Generic) | $0 | $0 | $0 | $0 |
| Tier 2 (Generic) | $8 | $16 | $24 | $20 |
| Tier 3 (Preferred Brand) | $47 | $94 | $141 | $118 |
| Tier 4 (Non-Preferred Drug) | 30% of cost | 30% of cost | 30% of cost | 30% of cost |
| Tier 5 (Specialty) | 30% of cost | 30% of cost N/A | N/A | N/A |