Unity Pharmacy
Unity's Pharmacy Program

The Quartz Pharmacy Program ​is managed by the University of Wisconsin Hospital and Clinics Pharmacy Department, a nationally recognized leader in the development and implementation of drug use policy in health care settings.


Based on local medical practice patterns and managed following NCQA best practices, this program helps provide effective medication management for patients.


The Prescription Drug Benefit brochure provides detailed information about Unity’s pharmacy benefits.

 


Opioid Risk Management Program

Quartz Health Solutions is committed to reducing the inappropriate use of prescription opioids. Excessive use of opioids can lead to addiction, overdose, and death. New restrictions will be in place effective 8/1/2018 for Quartz (fully-insured) commercial members. These restrictions will limit:

  • The number of days’ supply that can be filled for opioid naïve members (7 days or less)
  • The dose of opioids members can receive (cumulative daily dose of 120 morphine milligram equivalents (MME) will require an approved Prior Authorization (PA)*
  • The use of opioids in combination with other medications that may be inappropriate

* In order to avoid interruptions in therapy, members who are currently using opioids at a dose >120 MME can continue filling their opioids until 12/1/2018. This provides current utilizers time to obtain a prior authorization to continue therapy. Current members who are identified as needing to complete a Prior Authorization will be notified of this new requirement.

‡ Prior Authorization criteria is as follows: ONE of the following conditions applies: cancer-related pain, hospice, palliative, end-of-life, or long term care (LTC) residence.

OR

ALL of the following apply:

  • Prescriber statement indicating the dose being prescribed is medically necessary AND
  • The PDMP has been checked in the past month AND
  • Pain contract is in place AND
  • Prescription for naloxone (example: Narcan nasal spray) sent to the pharmacy AND
  • Urine compliance screen in previous 12 months

Unity’s Specialty Pharmaceuticals Program

Unity’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 Unity's network


The Unity Drug Formulary includes the designation of “SP” if the medication is in the Specialty Pharmaceuticals program. Call UW Health Pharmacy at 866.894.3784 with questions or to help enroll a patient.


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



Patient Medication Costs

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


Unity 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.

 

Important note: This pharmacy information is not applicable to members covered under the State of Wisconsin health insurance program or the BadgerCare Plus program.  State of Wisconsin members should contact Navitus Solutions and BadgerCare Plus members should call the State Medicaid Program.