If you have Quartz' pharmacy benefit, here are answers to the most frequently asked questions.
Drugs may fall into the following categories –
To see which drugs need Medication Prior Authorization, check your formulary.
You can also see the Medication Prior Authorization List.
Does your doctor or nurse give you your medicine (through an IV, for example)?
If so, you may need an approved Prior Authorization first. Be sure to check the Medication Prior Authorization List. If the medicine is on that list, you need to get a Medication Prior Authorization.
Your clinic staff can help you.
You or your doctor can fill out a Medication Prior Authorization Request (PA Request). Or your designated representative can fill it out. You can send it in via the web, fax, mail, or telephone.
It makes the most sense to have your doctor / nurse or pharmacist fill out the PA Request for you. They will have your medical history information that is needed. That means the PA Request can be reviewed more quickly.
Print Medication PA Request Form
(Fax using a secure fax number).
Once Quartz gets the Medication PA Form, we make a decision as soon as possible. However, if we don’t have all the information and have to ask questions, it can take up to 15 days.
Once a decision is made, we will send a notice to you and your doctor.
Requests will only be treated as urgent for documented clinical reasons. Otherwise the request will be processed normally.
The Quartz Pharmacy & Therapeutics (P&T) Committee creates and updates the prescription drug formulary. This committee is made up of doctors and pharmacists who care for Quartz members. The P&T Committee meets every month to review medications. They decide the formulary status and restriction status of each medication.
A variety of factors are considered. They include safety, side effects, drug interactions, how well the drug works, dosing schedule and dose form, appropriate uses and cost-effectiveness. In making formulary decisions, the committee uses the most up-to-date information on the medication from a variety of sources. These include published clinical trials, data submitted to the Food and Drug Administration (FDA) for drug approval and recommendations from local or national treatment guidelines. Additionally, the committee asks for information from local health care practitioners who are experts in the use of the drug class under review.
The Formulary is updated monthly.
Most changes involve adding new drugs or drugs that are newly available in generic form. At times, drugs are removed from the formulary or moved to restricted status. Check the website or request an up-to-date version from Quartz Customer Service.
Quarterly updates are listed on the formulary page for each specific formulary on the website.
When new, patented drugs enter the market, they are called brand drugs. These branded drugs are protected by patents that last up to 17 years. They are usually more expensive. After the patent expires, other companies can make drugs with the same active ingredients. These drugs are called generics, and they are usually cheaper. The first version of a medication on the market is usually called “the brand.” An example is Prozac, which is another name for the drug fluoxetine.
After the Prozac patent expired, other companies are marketing versions of the medication. These versions are called “generics.” Determining brand / generic status is not always easy. The P&T committee uses a national database of medication-related information called the First Data Bank National Drug Data File. The brand or generic status of a medication as listed in First Data Bank determines whether that medication is considered a generic or a brand on the Drug Formulary.