Gundersen Minnesota Quartz Medicare Advantage
Pharmacy Benefits
Get more from your Medicare plan.
Choose Quartz Medicare Advantage for more support, more benefits, more extras, more doctors, and more experience.
Part D prescription drug coverage
Available with Gundersen Minnesota Quartz Medicare Advantage (HMO) Core D, Value D, and Elite D plans.
You won’t pay more than $35 for a one-month supply of covered insulin, no matter what cost-sharing tier it’s on.
2024 Copayment table, Formulary, Drug prices, and Pharmacy network
View the 2024 Formulary, Drug prices, and Pharmacy network.
| Retail 30-day | Retail 60-day | Retail 90-day | Mail Order 90-day | |
|---|---|---|---|---|
| Tier 1 (Preferred Generic) | $5 | $10 | $15 | $12.50 |
| Tier 2 (Generic) | $15 | $30 | $45 | $38 |
| Tier 3 (Preferred Brand) | $47 | $94 | $141 | $117.50 |
| Tier 4 (Non-Preferred Drugs) | $100 | $200 | $300 | $300 |
| Tier 5 (Specialty Tier) | Core D = 28% Value D = 29% Elite D = 30% | N/A | N/A | N/A |
| Tier 6 (Vaccines) | $0 | N/A | N/A | N/A |
Initial Coverage Gap begins at: $5,330 | Catastrophic Coverage begins at: $8,000
Note: Part D vaccines (e.g. Tetanus (Tdap), shingles, etc.) are covered at no cost to you. You will need to submit a reimbursement request form for vaccines received in a clinic.
There is a deductible for Tiers 3, 4, and 5. Deductible is: Core D $300; Value D $250; Elite D $200.
2023 Copayment table, Formulary, Drug prices, and Pharmacy network
| Retail 30-day | Retail 60-day | Retail 90-day | Mail Order 90-day | |
|---|---|---|---|---|
| Tier 1 (Preferred Generic) | $2 | $4 | $6 | $5 |
| Tier 2 (Generic) | $15 | $30 | $45 | $38 |
| Tier 3 (Preferred Brand) | $45 | $90 | $135 | $113 |
| Tier 4 (Non-Preferred Drug) | $100 | $200 | $300 | $300 |
| Tier 5 (Specialty) | 33% of cost | N/A | N/A | N/A |
| Tier 6 (Vaccines) | $0 | N/A | N/A | N/A |
Initial Coverage Gap begins at: $4,660 | Catastrophic Coverage begins at: $7,400