Page Updated On 07/27/2022
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.
2023 Part D Prescription Drug Coverage
Available with Quartz Medicare Advantage (HMO) Code D, Value D, and Elite D plans.
| | 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