Standard Formulary

For members with high-deductible (HSA), one- or two-tier, or coinsurance benefit plans.

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 in which your employer is based
• 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 Service at (608) 881-8271 or (800) 897-1923 to verify your coverage.

• Standard Formulary Updates
• Future Formulary Updates