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Are generic drugs safe?

Are generic drugs safe and/or effective?

Yes, according to the Federal Food and Drug Administration (FDA) generic drugs are safe and effective. Generic medications must meet the same standards for purity, strength, and quality as brand name drugs. They must be approved by the FDA before they can be sold to consumers.

Generics may look different from the brand name medication in color, shape, or size as required by the Federal Food and Drug Administration (FDA). For more information visit the FDA’s Office of Generic Drugs.

If you are interested in switching to a generic, you may talk with your pharmacist and / or provider to find out if a generic equivalent is available in the drug(s) you current take, and to determine if a generic is right for you.

Changes in a drug's formulary status

A drug changes from preferred to non-preferred

If your drug changes from preferred to non-preferred, your coverage continues at a Tier 3 copay.

In other words, your copay will be higher, but you will not pay the full cost of the drug.

If you want to keep your copay at the same level, ask your doctor to find a similar formulary drug.

If you have had a recent claim for the medication as a Quartz member, you and your practitioner will receive a notification of the formulary change and your options BEFORE the change occurs. You will be given sufficient time to discuss your options with your practitioner and make a decision.

You generally have two options –

  • Continue taking the drug at the Tier 3 copay level
  • Switch to an appropriate preferred version of the medication to receive coverage at the preferred copay level

A drug changes to restricted status

If you are taking a drug that becomes restricted, your coverage may change in one of two ways.

The change is based on the type of drug and the nature of the disease it treats. You will continue to receive coverage for the drug from Quartz. This happens when the P&T Committee believes that it is not safe to stop taking the medication. Another reason is that sometimes switching to another medication is complex and difficult. In either case, your coverage for the drug will continue without the need for Prior Authorization.

Only patients who are new to the drug after it becomes restricted need Prior Authorization to receive coverage. Coverage for the newly restricted drug will end and a different medication will be suggested. You and your doctor will be notified before the restriction occurs. You will both be given information about similar drugs that are not restricted.

In general, you have three choices to review with your doctor:

  1. Switch to a similar formulary drug that does not require Prior Authorization. This drug will be covered at the formulary copay level
  2. Ask your doctor to request Prior Authorization for continued coverage of the restricted drug
  3. Continue taking the restricted drug without coverage (you pay the full cost)
Lowest copay & supply

How do I make sure the medicine my doctor gives me is at the lowest copay?

Before your doctor writes a prescription, tell your doctor that you prefer generic or formulary drugs if possible.

That will help the doctor find the drugs with the lowest copay.

If your doctor gives you drug samples to start treatment, it’s best to find out if that specific drug is on the formulary. Starting with samples does not mean that the drug will be covered or have the lowest possible copay.

You can also check the price you would pay for any medication by using the online Pharmacy Benefit Tool within MyChart.

Why does Quartz only pay for a one-month supply of medication at a time?

First, limiting coverage to one month reduces waste that occurs when a medication is switched or the dosage changes. Even medications that you have been taking for a long time may unexpectedly change. Proper disposal of unused drugs is difficult, so it’s best to have less to throw away.

Second, Quartz wants to keep costs down for active members. A one-month supply doesn’t allow stockpiling of medication by those who are planning to end their membership. If the medication you take is considered a maintenance medication, it may qualify for the Choice90 program.

How do I request reimbursement for a prescription?

How do I request reimbursement for a prescription I paid for myself?

For Quartz Claims, please fill out (or have your pharmacist fill out) the Direct Member Reimbursement Form. Be sure to include all receipts. Prescription medications will be reimbursed through the Quartz Pharmacy Benefits Management (PBM) at our current discount contracted rates. Any difference between the discount contracted rate and what the pharmacy or health care provider has billed will be your responsibility.

What is my copay if the medication is in a box that lasts more than 30 days?

What is my copay if the medication is in a box that lasts more than 30 days?

Some maintenance medications such as insulin pens and inhalers are packaged in a box that is not easily broken into a 30-day supply. These are considered "unbreakable packages." Quartz allows the pharmacy to submit the correct days’ supply based upon your prescribed dose (e.g., one copay for prescriptions that last one to 30 days, two copays for prescriptions that last 31-60 days, and three copays for prescriptions that last 61-90 days).