The amount you pay for your medication(s) can be located in your Plan's Summary of Benefits document.
To promote the most appropriate utilization, certain medications require an approval of a prior authorization by our Pharmacy Department. Upon enrollment or upon request, the member will receive a list of prior authorized prescription drugs. These medications are also identified on the Formulary with a (PA) after the drug name. Prior authorization criteria is established by our Pharmacy and Therapeutics Committee with input from plan physicians and consideration of the current medical literature. If a medication is required that is not routinely covered, the provider may present medical evidence to obtain an individual patient exception by submitting an exception request for review.
As a member of Quartz Medicare Advantage, you may initiate an exception request process. For your convenience, we have prepared a form that you may complete and fax or mail to us. To complete the Drug exception request click here.
