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.
The Specialty Pharmaceutical Program gives high-quality clinical monitoring to patients using approved medications. The goal is to help the patients stay healthy and keep coverage of these medicines affordable. The majority of drugs included in Quartz's Specialty Pharmacy network have pharmacist-run management programs to maximize patient knowledge and outcomes from these medications. This may include additional follow-up from the pharmacist or partial dispensing protocols.
Specialty medications must have prior authorization and must be provided by a pharmacy in the Specialty Pharmaceutical Program (UW Health and Gundersen Health System Pharmacies). Members will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy.
To see if your medication is part of the program, check the Unity Formulary. Medications included in this program are noted with an "SP." Many of these medications require a Medication Prior Authorization, noted by "PA"
Have your doctor or nurse submit a Medication Prior Authorization Form for your medication to Quartz Pharmacy Program.
If your medication is approved, call to start the enrollment process –
Answer the questions from the pharmacy staff. They will also discuss delivery or pick-up. They will contact your doctor or nurse to get a copy of the prescription.
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.