Unity Pharmacy
​Pharmacy Program Updates

​Prior Authorization

PA criteria for medical benefit list updated MONTHLY.

  • Please check on a regular basis as criteria often change. Go to this page.

Miscellaneous Drug Codes

Miscellaneous J Code medications administered in a clinic or outpatient hospital setting with a Billed Amount greater than $2,500 requires Prior Authorization

  • J3490-Unclassified drugs
  • J3590 or C9399-Unclassified biologics
  • Other codes could include J7999, J7599, J8999, J8499
  • When J code is updated, use most appropriate code

Formulary Changes

In 2018, Quartz members could have the option of different formularies. Many factors are influencing formulary changes, including:

  • GHP, GHP-MN, Unity and PPIC have different formulary contracts that will remain effective through 2018
  • Members may transition from one pharmacy benefit to another
  • Participants transition from one payor to another as marketplace evolves

How do I know what formulary a member or participant uses?

Refer to the Quartz ID card for Subscriber / Participant Number and Group Number to direct you to the appropriate formulary.

The Complex Case Management Fax Number Has Changed!
It is now:  608.833.3203