Quartz Dual Eligible Members
Drug Coverage
The copay is the amount you pay when you get a prescription filled. A copay may be a flat-dollar amount or a percentage of the total cost of a drug.
Drug maintenance
Prescriptions are often sold in 30-day supplies. However, you can buy up to a 90-day supply of medications in tiers 1 through 4. Each 30-day supply will take one copay at a retail pharmacy. A 90-day supply equals three copays.
If you live in a long-term care facility, your copay is the same as in a retail pharmacy.
You can get prescriptions from an out-of-network pharmacy, but you may pay more.
2023 Copay Amounts
Part D vaccines are covered at no cost to you. You won’t pay more than $35 for a one-month supply of covered insulin, no matter what cost-sharing tier it’s on.
Quartz Medicare Advantage Dual Eligible plans
| | Deductible | Retail 30-day | Retail 60-Day | Retail 90-Day | Mail Order 90-Day |
|---|---|---|---|---|---|
| Tier 1 (Preferred Generic) | $505 | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 2 (Generic) | $505 | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 3 (Preferred Brand) | $505 | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 4 (Non-Preferred Drug) | $505 | 25% of cost | 25% of cost | 25% of cost | 25% of cost |
| Tier 5 (Specialty) | $505 | 25% of cost | Not offered | Not offered | Not offered |
| Tier 6 (Vaccines) | $0 | $0 | Not offered | Not offered | Not offered |
Initial Coverage Gap begins at: $4,660 | Catastrophic Coverage begins at: $7,400