Page Updated On 07/27/2022
Medicare Advantage
UW Health 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) | $3 | $6 | $9 | $7 |
| 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
Formularies
- View the 2023 Formulary
- Online Searchable Formulary
- 2023 Prior Authorization Criteria (Coming Soon)
- 2023 Step Therapy Criteria (Coming Soon)
2022 Part D Prescription Drug Coverage
Available with Quartz Medicare Advantage (HMO) Code 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 |
Formularies
- VIEW THE 2022 FORMULARY
- ONLINE SEARCHABLE FORMULARY
- FORMULARIO 2022
- 2022 PRIOR AUTHORIZATION CRITERIA
- 2022 STEP THERAPY CRITERIA