Specialty Pharmacy is a service to manage a group of complex medications that are used to treat chronic health problems.

What is a Specialty Pharmaceutical?

Specialty pharmaceuticals are a group of high-cost medicines that are used to treat chronic health problems. These therapies tend to be more complicated and more costly than others. They may require special storage, regular lab testing, screening tests and may be given by injection or orally. To get the most benefit, regular adherence to the regimen is needed.

What is the Quartz Specialty Pharmaceutical Program?

The Specialty Pharmaceutical Program gives high-quality clinical monitoring to patients using approved medications. The goal is to help members stay healthy and keep coverage of specialty medicines affordable.

Specialty medications will only be covered when provided by a pharmacy in the Quartz Specialty Pharmacy Network. Members will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy.

  • Some examples of drug classes in this program include (but are not limited to):
  • Some HIV Therapies
  • Some Oral Oncology Medications
  • Growth Hormones
  • Hepatitis C Agents
  • Multiple Sclerosis Agents
  • Biologic Response Modifiers (used for rheumatoid arthritis, Crohn's disease and others)

To see if your medication is part of the program, check your Formulary. Medications included in this program are noted as being Tier 4 (Specialty).

Please note: this program does not apply to drugs given by a doctor or nurse in a clinic, hospital or other health care facility. This program applies to drugs available on an outpatient basis.

How to get your medicines from the Specialty Pharmaceutical Program:

  1. Obtain Prior Authorization. If the medication requires a Prior Authorization, have your doctor or nurse submit a Prior Authorization Form.
  2. Contact your Approved Pharmacy. If your request is approved, call UW Health Pharmacy (866-894-3784) or Gundersen Clinic Pharmacy (877-208-1096) to start the enrollment process.
  3. Answer Questions from the Pharmacy Staff. They will also discuss delivery or pick-up. They will contact your provider to get a prescription order for the medication.

Program Disclaimers:

This program does not apply to drugs given by a doctor or nurse in a clinic, hospital or other health care facility.

This program DOES NOT apply to members covered under the State of Wisconsin Health Insurance Program, who have Navitus for their drug benefit or those members with BadgerCare Plus.

Any Wisconsin pharmacy that is in Quartz's participating pharmacy network and can meet the terms and conditions can participate in Quartz Specialty Pharmaceutical Program. Pharmacies may contact the Quartz Pharmacy Program at (888) 450-4884 for a copy of the terms and conditions or to apply to participate.