Pharmacy Benefits

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Overview

Quartz offers many kinds of prescription drug coverage. To learn about your drug coverage, login to MyChart.

Your drug coverage may include different types of payments. These can be copays, coinsurance, or other out-of-pocket costs.

Once you know what your coverage is, go to the Drug Formulary. This lists all drugs covered on the drug benefit.  It also notes what medications need a Prior Authorization before Quartz will pay for them.


  • State and Local Government Members, please visit Navitus for information about your prescription drug benefits.
  • BadgerCare Plus members please call the Department of Health and Family Services at (800) 362-3002 for information about your prescription drug benefits.
Choice90 & Step Therapy

Choice90 Extended Supply Program (Maintenance Medications)

Choice90 makes it easy to receive a 90 day supply of the medicine you take most often.

You can get a 90-day supply of certain medicines from your local pharmacy. More than 1,000 pharmacies in Wisconsin participate in the program. Choice90 offers greater flexibility and expands pharmacy choices.

  • Your medicine may be covered in the Choice90 program if
  • The medication is listed as a maintenance medication in national databases
  • The cost of a 90-day supply is within the Choice90 limits
  • All other benefit requirements have been met including prior authorization, step therapy, generic substitution and quantity requirements*

The Quartz Drug Formulary flags all drugs that are maintenance medications (Choice90) with the notation "MM".

Participating pharmacies are listed the Pharmacy Search.

More than 1,000 participating pharmacies in Wisconsin participate in Choice90.

If you want your medication mailed to you, ask your pharmacy if they offer free mailing or delivery before you enroll. Many pharmacies offer this service, so shop around. This is NOT a program requirement.

Medications included in the Quartz Specialty Programs are not part of the Choice90 program. These medications are listed with “T4” in the drug formulary.

Step Therapy Program

Sometimes there are a lot of different drugs that treat the same illness. Some may cost very little and others may be very expensive, but work just as well. That’s why Quartz has the Step Therapy Program. Step Therapy means that members must try the most cost-effective medications before stepping up to a more expensive drug. Many members find the first medication very effective and never need to step up.

Step therapy medications need Prior Authorization for coverage. Every Prior Authorization Request for step therapy drugs is reviewed separately. Each drug has specific criteria for approval.

Preferred or non-preferred drugs may be included in a step therapy program.

Go to the Quartz formulary to see which drugs have a "ST". These require Prior Authorization.

Drug Supply Policies
Opioiod Risk Management Program

Opioid Risk Management Program

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Extended International Travel Medication Supply

Oncology Split Fill Program

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New Member Drug Supply

Members new to Quartz may be taking medicines that need a Prior Authorization for coverage. Quartz's formulary will note the drugs that need Prior Authorization. In this case, Quartz will authorize coverage for these drugs for up to 90 days (in 30 day increments at the usual copayment). After those 90 days, prior authorization will be required for additional coverage. In the meantime, new members should talk to the doctor who prescribed the medicine. The doctor can check to see if a different drug will work.

To request a “New Member Override,” you or your pharmacy can call Quartz Pharmacy Services at (800) 788-2949. This should be done within the first 90 days of becoming a Quartz member.

Please note: this policy only applies to medications that a member was taking prior to joining Quartz. Standard copays based on the member’s drug benefit and formulary status of the medication apply.

Medications that were covered by your previous insurance prescription drug benefit do qualify for a New Member Drug Supply.

Medications that do not qualify for a New Member Drug Supply include

  • Medications that were not covered by your prior insurance drug benefit
  • Medications provided by Sponsored Free Drug Programs from drug companies

 

Emergency Drug Supply

At times, you may have an urgent need for medicine that requires Prior Authorization. If you don’t have time to wait for Prior Authorization approval, talk to your pharmacist. Your pharmacy can call Quartz Pharmacy Services at 800.788.2949 to get coverage for a five-day emergency supply. During the five days, it is your responsibility to talk to your doctor. Ask your doctor for a similar medicine or ask the doctor to submit a Drug Prior Authorization Request Form to ensure continued coverage.

The emergency supply policy does not apply to all medications. It does not include drugs that –

  • Are excluded from coverage on your Prescription Drug Benefit
  • You have had previous emergency coverage

No copay is charged for the emergency supply. A full copay is charged for any additional orders of the medication.

 

Vacation Drug Supply

Members who are planning to travel should make sure they have enough medication for their entire trip. Do this in one of three ways –

  1. Call Quartz Pharmacy Services at (800) 897-1923 to get approval for an extra 30-day supply to take with you (copays apply).
  2. You can have your pharmacy send your medicine to your vacation address.
  3. Or, you can go to a Quartz-participating pharmacy where you’re staying. Quartz has a national network of participating pharmacies from which you can receive medications.

    These pharmacies include CVS, KMart, Kroger, Longs, Medicine Shoppe, Osco, Publix, Rite Aid, SafeMart, Shopko, Target, Walgreens, Walmart and more. Use Quartz’s Find a Pharmacy (and select the Pharmacy Search button) tool or contact Quartz Pharmacy Services for help identifying participating pharmacies in the area where you’re traveling.

    To pick up your prescription at one of these pharmacies, you need to call ahead give them the name and phone number of the pharmacy where you last filled the prescription. They will call and transfer the remaining refills.

At times, you may need to pay the full cost of a prescription when traveling. In this case, you can fill out a Direct Member Reimbursement Form and include proof of payment. Quartz will pay you back based on your plan coverage.

 


This health plan is underwritten by Gundersen Health Plan, Inc.