Standard Choice Formulary

For members whose pharmacy benefits are covered by a fixed copay on a three- or four-tier plan.

The formulary is the list of medications covered by Quartz through the prescription drug benefit. This formulary includes drugs covered for ALL fully insured policies.

Certain drugs on the formulary may not be covered by your specific plan. Some plans cover drugs not listed on the formulary. The differences are based on what type of plan you have and/or:

• If you have employer-based or individual coverage through Quartz
• What state you live in or your employer is based in
• If your benefit plan meets the requirements of the Affordable Care Act

This means that even though a drug is listed on this formulary, it may not be covered by your specific benefit plan. Please see your Quartz Prescription Drug Benefit Rider or contact Quartz Customer Success at (608) 881-8271 or (800) 897-1923 to verify your coverage.

• Standard Choice Formulary Updates
• Future Formulary Updates