Page Updated On 11/15/2022
Medicare Advantage
Gundersen health system 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 Quartz Medicare Advantage (HMO) Code D, Value D, and Elite D plans.
You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter its cost-sharing tier.
| | 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