2025 Pharmacy Coverage
Commercial Large Group - Illinois
Understanding what Quartz covers and what you'll pay for drugs
Taking your medications as directed is an important aspect of maintaining your health. We are here to support you with a variety of resources and tools to assist you in filling your prescriptions, estimating costs, and accessing expert help.
2025 prescription drug coverage
A drug list, often referred to as a formulary, includes the preferred medications of your health plan. Typically, you may find that choosing a medication from this list can result in lower costs. We offer search tools that can help you easily determine whether your prescriptions are included, and you may also discover alternative options that could be more affordable.
Your medication list may vary based on your insurance plan. For the most complete and accurate information, we recommend logging into your Quartz MyChart account.
You can also view the drug lists without signing in. You’ll need to know which drug list your health plan uses. You can find this information in your 2025 plan documents or by calling Optum Member Services at (800) 496-7509. Here is the common formulary
- 4-Tier Formulary (categorizes medications into four levels or “tiers” for example, $10/$35/$50/$200)
Helpful resources for your pharmacy and prescription needs
Formulary exception requests
The formulary is a list of medications that are covered by Quartz. If the member is taking a medication that is not on the formulary, you can ask for an exception to the formulary.
Exceptions include:
- Drugs that are not covered by the plan (non-formulary)
- Drugs that are covered, but there are restrictions on the drug. For example,
- You need to try drug A to see if it will work before drug B can be covered (step therapy), or
- There are limits on the number of tablets covered per day (quantity limit)
If you believe the member has a medical reason for an exception, you can request an exception by submitting a Prior Authorization Request form.
What to do if your drug is not on the formulary
- Change to another drug. Determine if another drug is on the formulary that might work just as well for the member.
- Submit a formulary exception request. Ask for an exception to see if Quartz will cover a non-formulary drug due to medical reasons. Such reasons include: – all of the similar drugs on the formulary would not be effective for the member or -they would cause side effects for the member.
Specialty Pharmaceuticals Program
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 the Quartz Specialty Pharmaceutical Program 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-QTZ”. 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 provider 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
- UW Health Northern Illinois Pharmacy at (888) 861-0854
Simply answer the pharmacy staff’s questions. They will contact your provider to get a copy of the prescription and discuss delivery or pick-up options for your medications.
Program disclaimers:
This program does not apply to drugs given by a provider 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 pharmacy that is in the Quartz 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 (800) 362-3310 for a copy of the terms and conditions, or to apply to participate.
Vaccine coverage
Coverage of select immunizations is available to you under your pharmacy benefit. Simply present your Quartz ID card to a network pharmacy. Contact your local pharmacy for information about vaccine and appointment availability. Limitations and restrictions may apply.
Examples of vaccines that can be obtained under the pharmacy benefit include, but are not limited to:
- Covid-19
- Influenza (flu)
- Pneumococcal (pneumonia)
- Shingles (herpes zoster)
- Tetanus/Whooping Cough (Tetanus, diphtheria, pertussis; TDaP)
- Hepatitis B
- HPV (human papilloma virus)
Contact us
Quartz is here to help. That’s why we make it easy to reach us.
Call Quartz Customer Success (800) 362-3310 or message us on Quartz MyChart.