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Quartz Standard Choice Formulary – 2022

Medication Coverage Request Form

Printable Formulary

Prior Authorization Criteria

How to Search For Drugs

1.     Search by typing part of the drug name in the box and press “Enter”.

2. Use the Alphabetical Search list to search by the first letter of your drug.

3. Search by selecting the Therapeutic Class of the drug you are looking for.

Alphabetical Search Skip to Brand & Generic Search

Brand & Generic Name Search


Therapeutic Class Search Skip to Footer

AllergyAntiemesis/AntivertigoAsthma And CopdAutonomic Nervous System DisordersBehavioral Health - AntidepressantsBehavioral Health - OtherCardiovascular Disease - ArrhythmiaCardiovascular Disease - Cardiac StimulantCardiovascular Disease - HypertensionCardiovascular Disease - Lipid IrregularityCardiovascular Disease - Miscellaneous AgentsCardiovascular Disease - VasodilationContraception/OxytocicsCough And ColdDermatology - AcneDermatology - AntiinfectiveDermatology - AntiinflammatoryDermatology - Antipruritic DrugsDermatology - MiscellaneousDermatology - Psoriasis/EczemaDiabetesEar - General DisordersElectrolyte RegulationEndocrine Disorder - FertilityEndocrine Disorder - OtherEndocrine Disorder - ThyroidEye - General DisordersEye - GlaucomaEye - MiscellaneousFluid ReplacementGout And Related DiseasesHematological DisordersHormonal DeficiencyImmunizationImmunosuppression/ModulationInfectious Disease - BacterialInfectious Disease - FungalInfectious Disease - MiscellaneousInfectious Disease - ParasiticInfectious Disease - ViralInflammatory DiseaseLocal AnesthesiaLower Gastrointestinal Disorders - Bowel InflammatLower Gastrointestinal Disorders - OtherMedical SuppliesMiscellaneous AgentsNeoplastic DiseaseNeurological Disease - MiscellaneousOral/Pharyngeal DisordersOther DrugsOther Respiratory DisordersPain Management - AnalgesicsParkinsons DiseaseSeizure DisorderSkeletal Muscle DisorderSmoking CessationUpper Gastrointestinal Disorders - DigestiveUpper Gastrointestinal Disorders - Spastic DiseaseUpper Gastrointestinal Disorders - Ulcer DiseaseUrinary Tract - Functional DisordersVaginal DisordersVitamin And/Or Mineral Deficiency
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For additional information on pharmacy benefits and programs please see the PRESCRIPTION DRUG BENEFIT BROCHURE or FREQUENTLY ASKED QUESTIONS. For questions about drug coverage or other benefits please CONTACT QUARTZ.
Formulary Effective Date: 08/01/2022

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