Specialty Pharmaceuticals Program
Specialty Pharmacy is a service designed to manage a group of complex medications that are used to treat chronic health problems. This program applies to Commercial and Health Insurance Marketplace plans sold in the states of Iowa, Illinois, and Wisconsin.
What is a Specialty Pharmaceutical?
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, and screening tests and may be given by injection or orally. To get the most benefit, regular adherence to the regimen is needed.
What is the Quartz Specialty Pharmaceutical Program?
The Specialty Pharmaceutical Program provides 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 taking these medications. This may include additional follow-up from the pharmacist or partial dispensing protocols.
Specialty medications may require a Prior Authorization and must be provided by a pharmacy in the Specialty Pharmaceutical Program. You will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy. Medications included in this program are noted with an “SP.” To see if your medication is part of the program and/or requires a prior authorization, review the Quartz Formulary.
How to get your medicines from the Specialty Pharmaceutical Program
If the medication requires a Prior Authorization, have your doctor or nurse submit a Medication Prior Authorization Form for your medication to the Quartz Pharmacy Program.
Call to start the enrollment process at one of our Participating Specialty pharmacies:
- Aurora Specialty Pharmacy at (844) 820-5600
- Gundersen Health System Pharmacies at (877) 208-1096
- UW Health Pharmacy at (866) 894-3784
Answer the questions from 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, those who have Navitus for their drug benefit, or 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 the 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.