Pharmacy Benefits

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2021 Part D Prescription Drug Coverage

Available with Quartz Medicare Advantage (HMO) Core D, Value D and Elite D plans.
 

30-day

Retail
60-Day

90-Day 

Mail Order
90-Day

 Yearly Deductible$150 Tiers 4-5$150 Tiers 4-5$150 Tiers 4-5$150 Tiers 4-5
 Tier 1 (Preferred Generic)$0$0$0$0
 Tier 2 (Generic)$12$24 $36 $30 
 Tier 3 (Preferred Brand)$47$94 $141 $118 
 Tier 4 (Non-Preferred Drug)  30% of cost 30% of cost 30% of cost 30% of cost
 Tier 5 (Specialty) 30% of cost N/A N/AN/A 

 

Initial Coverage Gap begins at: $4,130
Catastrophic Coverage begins at: $6,550

This webpage was updated on October 19, 2020.