Quartz Dual Eligible Members Drug Coverage & Copays
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.
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.
Copay amounts
Extra help copay if you have Low Income Subsidy (LIS) Level 3
| | Retail 30-day | Retail 60-day | Retail 90-day | Mail order 3-month |
|---|---|---|---|---|
| Generic drugs | $0 | $0 | $0 | $0 |
| Brand/other drugs | $0 | $0 | $0 | $0 |
| Vaccines | $0 | $0 | $0 | $0 |
Extra help copay if you have LIS Level 2
| | Retail 30-day | Retail 60-day | Retail 90-day | Mail order 3-month |
|---|---|---|---|---|
| Generic drugs | $1.55 | $1.55 | $1.55 | $1.55 |
| Brand/other drugs | $4.60 | $4.60 | $4.60 | $4.60 |
| Vaccines | $0 | $0 | $0 | n/a |
Extra help copay if you have LIS Level 1
| | Retail 30-day | Retail 60-day | Retail 90-day | Mail order 3-month |
|---|---|---|---|---|
| Generic drugs | $4.50 | $4.50 | $4.50 | $4.50 |
| Brand/other drugs | $11.20 | $11.20 | $11.20 | $11.20 |
| Vaccines | $0 | $0 | $0 | $0 |
Standard Part D benefit – Does not receive Extra Help
| | Retail 30-day | Retail 60-day | Retail 90-day | Mail order 3-month |
|---|---|---|---|---|
| Generic and Brand/other drugs | Deductible $545, then 25% coinsurance | Deductible $545, then 25% coinsurance | Deductible $545, then 25% coinsurance | Deductible $545, then 25% coinsurance |
| Insulins | $35 | $70 | $105 | $105 |
| Vaccines (Cost-sharing Tier 6) | $0 | n/a | n/a | n/a |