Medicare Advantage

UW Health Pharmacy Benefits

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2022 Part D Prescription Drug Coverage

Available with Quartz Medicare Advantage (HMO) Core D, Value D, and Elite D plans.

	30-day	Retail 60-Day	90-Day	Mail Order 90-Day
Yearly Deductible	$0	$0	$0	$0
Tier 1 (Preferred Generic)	$3	$6	$9	$7
Tier 2 (Generic)	$15	$30	$45	$38
Tier 3 (Preferred Brand)	$45 $35 for select insulins	$90 $70 for select insulins	$135 $105 for select insulins	$113 $87 for select insulins
Tier 4 (Non-Preferred Drug)	40% of cost	40% of cost	40% of cost	40% of cost
Tier 5 (Specialty)	30% of cost	N/A	N/A	N/A
Tier 6 (Vaccines)	$0	$0	$0	$0

Initial Coverage Gap begins at: $4,430 | Catastrophic Coverage begins at: $7,050

Formularies

2021 Part D Prescription Drug Coverage

Available with Quartz Medicare Advantage (HMO) Core D, Value D, and Elite D plans.

	30-day	Retail 60-Day	90-Day	Mail Order 90-Day
Yearly Deductible	$0	$0	$0	$0
Tier 1 (Preferred Generic)	$3	$6	$9	$7
Tier 2 (Generic)	$15	$30	$45	$38
Tier 3 (Preferred Brand)	$45	$90	$135	$113
Tier 4 (Non-Preferred Drug)	40% of cost	40% of cost	40% of cost	40% of cost
Tier 5 (Specialty)	30% of cost	N/A	N/A	N/A

Initial Coverage Gap begins at: $4,130 | Catastrophic Coverage begins at: $6,550

Check Drug Prices and Pharmacy Network

Core D

Value D

Elite D

Formularies

Welcome. We're Happy You're Here!

Thank you for choosing Quartz Medicare Advantage. We are honored that you have entrusted us with your health insurance needs, and we are committed to making your experience be the best it can be.