Physicians Plus 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 Physicians Plus Drug Formulary. This lists all drugs covered on the drug benefit. It also notes what medications need a Prior Authorization before Physicians Plus will pay for them.
Get a three-month supply of your medications delivered right to your door with Home Delivery! A list of frequently asked questions regarding Home Delivery from Express Scripts can be found here.
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 Physicians Plus 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 Physicians Plus formulary to see which drugs have a "ST". These require Prior Authorization.
Members new to Quartz may be taking medicines that need a Prior Authorization for coverage. Physicians Plus 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 Physicians Plus Pharmacy Services at (800) 545-5015 or (608) 260-7803. 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 Physicians Plus. 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 –
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 Physicians Plus Pharmacy Services at (800) 545-5015 or (608) 260-7803 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 Print Medication Prior Authorization Request Form to ensure continued coverage.
The emergency supply policy does not apply to all medications. It does not include drugs that –
No copay is charged for the emergency supply. A full copay is charged for any additional orders of the medication.
Members who are planning to travel should make sure they have enough medication for their entire trip. Do this in one of three ways –
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. Physicians Plus will pay you back based on your plan coverage.
This health plan is underwritten by Physicians Plus Insurance, Inc.