The formulary is a list of medications that are covered by Quartz Medicare Advantage (HMO). If you are taking a medication that is not on the formulary, your doctor can ask for an exception to the formulary.
Exceptions include –
If your doctor believes you have medical reasons for an exception, he or she can help you request an exception. They may submit a Coverage Determination Request.
If you are a current member and a drug you are taking will be removed from the Formulary or restricted in some way for next year, we will allow you to request an exception in advance for the next year. We will give you an answer to your request for an exception before the change takes effect.
Tier Exceptions are not allowed for: