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 members stay healthy and keep coverage of specialty medicines affordable.
Specialty medications will only be covered when provided by a pharmacy in the Quartz Specialty Pharmacy Network. Members will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy.
Some examples of drug classes in this program include (but are not limited to):
To see if your medication is part of the program, check your Formulary. Medications included in this program are noted as being Tier 4 (Specialty).
Please note: this program does not apply to drugs given by a doctor or nurse in a clinic, hospital or other health care facility. This program applies to drugs available on an outpatient basis.
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.