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Provider Pharmacy Program

The Quartz Pharmacy Program is based on local medical practice patterns and managed following NCQA best practices, this program helps provide effective medication management for patients.

Benefit Overview

The Prescription Drug Benefit Brochure provides detailed information about Quartz’s pharmacy benefits.

Patient Medication Costs

You can determine the copay level (tier) for your patient’s medications by reviewing Quartz’s Drug Formulary. The formulary lists medications by drug class according to the copay tier.

Quartz populates formulary information with the Surescripts hub for use in e-prescribing applications. Surescripts will display the copay tier of the medication.

Certain medications require prior authorization before coverage is provided.

Quartz’s Specialty Pharmaceuticals Program

Quartz’s Specialty Pharmaceutical Program provides high-quality clinical monitoring for patients using specialty medications while helping keep coverage of these products affordable.

Specialty medications are only covered with an approved Medication Prior Authorization and if obtained through a Pharmacy in Quartz’s network.

The Quartz Drug Formulary includes the designation of “SP” if the medication is in the Specialty Pharmaceuticals program. Call UW Health Pharmacy at (866) 894-3784 or Gundersen Health System Pharmacies at (877) 208-1096 with questions or to help enroll a patient in the Specialty Pharmaceuticals program.

Please note: The Specialty Pharmaceuticals Program does not apply to medications administered in the physician’s office, a hospital or other health care facility.

Vendor Solution Drug Program

Pharmaceuticals provide much-needed innovative therapies for patients. However, they also have a significant impact on health care costs. When those drugs are administered in a health care setting, the price markup ranges from 2-10 times the facility’s cost. And costs continue to rise, often creating a significant financial burden for patients who need these drugs. Quartz has a similar burden for our share of the costs. 

At Quartz, we believe in helping our members get the care they need at the right cost. That’s why we are implementing changes in our reimbursement practices for drugs given in the doctor’s office or other health care settings.

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