Does Quartz Health Solutions Cover Adderall?

What Is Quartz Health Solutions and How Does Its Formulary Work?

Quartz Health Solutions is a Wisconsin-based health insurer offering commercial, marketplace, Medicare Advantage, and employer-sponsored plans across Wisconsin and parts of Illinois, Iowa, and Minnesota. Each plan type maintains its own drug formulary, which is a tiered list that determines what you pay for specific medications.

Formulary Tiers Explained

Quartz uses a standard multi-tier formulary structure. Tier 1 typically covers preferred generics at the lowest copay. Tier 2 covers non-preferred generics and some preferred brands. Tier 3 covers non-preferred brands. Specialty tiers handle high-cost biologics and other complex drugs.

Generic amphetamine/dextroamphetamine tablets most commonly land at Tier 2 on Quartz commercial plans, meaning a typical 30-day copay ranges from roughly $10 to $45 depending on the specific plan design. Brand-name Adderall XR, when covered at all, often sits at Tier 3 with copays of $40 to $100 or more before any deductible is met.

Why Your Specific Plan Document Matters

Quartz offers dozens of distinct plan designs. A small employer group plan may carry a different formulary than a marketplace silver plan or a Medicare Advantage plan. The only definitive answer for your coverage sits in your Summary of Benefits and Coverage (SBC) and your plan's Evidence of Coverage document, both available through your Quartz member portal or by calling the member services number on your insurance card.

Checking the Quartz online formulary search tool with your exact plan name and the drug's NDC or name is the fastest verification step.

Is Adderall a Controlled Substance, and Why Does That Affect Coverage?

Adderall and its generic equivalents contain amphetamine salts classified as Schedule II controlled substances under the Controlled Substances Act. That scheduling has direct consequences for insurance coverage, prescribing logistics, and pharmacy dispensing rules.

Schedule II Dispensing Restrictions

Federal law prohibits refills on Schedule II prescriptions. Each fill requires a new written or electronic prescription from a licensed prescriber. Most state pharmacy boards and most health plans, including those administered by Quartz, limit Schedule II stimulant fills to a 30-day supply per dispense.

The DEA's Controlled Substances Act is enforced at the federal level, while state pharmacy rules add an additional layer. Wisconsin, where Quartz is headquartered, follows standard federal Schedule II rules with no broader state-level restrictions that meaningfully loosen or tighten those limits for commercially insured patients.

The 2022 to 2025 Amphetamine Shortage

The FDA has maintained an active drug shortage designation for amphetamine mixed salts since late 2022. The FDA's shortage database lists multiple amphetamine/dextroamphetamine products as currently or recently in shortage. Shortage status does not change your insurance benefit, but it does mean your pharmacy may be unable to dispense even a covered medication. Calling ahead to confirm stock before submitting a prescription can save significant time.

Does Quartz Require Prior Authorization for Adderall?

Prior authorization (PA) is the process by which your insurer reviews clinical information before agreeing to pay for a specific drug. For brand-name Adderall and Adderall XR, most Quartz commercial plans require PA. Generic amphetamine/dextroamphetamine immediate-release tablets are less likely to need PA on standard commercial plans, but extended-release generics sometimes do.

What Prior Authorization for Adderall Typically Requires

When a Quartz PA is required for an amphetamine product, the prescriber generally must document:

• A confirmed ADHD diagnosis consistent with DSM-5 criteria
• The patient's age and weight (pediatric dosing thresholds may apply)
• Any prior stimulant trials and their outcomes
• For extended-release formulations: clinical justification for XR over immediate-release
• For brand-name products: evidence that the generic was tried and was either ineffective or caused documented adverse effects

The American Psychiatric Association's practice guidelines for ADHD note that stimulant medications are the first-line pharmacological treatment for ADHD across the lifespan, a point that supports PA approval when documentation is thorough. APA Practice Guidelines are accessible through the APA's hosted pages, and Quartz medical reviewers reference similar evidence standards during PA decisions.

Step Therapy: Generics First

Quartz, like most commercial insurers, applies step therapy to brand-name stimulants. Step therapy means you must try a preferred generic first, typically for 30 to 90 days, before the plan will cover a non-preferred brand. If the generic amphetamine/dextroamphetamine tablet causes adverse effects (for example, unacceptable mid-afternoon rebound, or a documented allergy to a specific inactive ingredient), your prescriber can document that trial and submit a PA requesting the brand product.

Step therapy exemptions may apply if you have documented prior use of the brand product before your Quartz enrollment began. Wisconsin state law has not enacted broad step therapy override statutes as of early 2025, so exemption requests rely on federal and plan-level protections.

What Will Adderall Cost With Quartz Coverage?

Cost depends on three intersecting variables: your plan's tier structure for the specific product, how much of your annual deductible remains, and whether a generic or brand is dispensed.

Generic Amphetamine/Dextroamphetamine Cost Estimates

A 30-day supply of generic amphetamine/dextroamphetamine 20 mg IR on a Quartz Tier 2 commercial plan typically falls between $10 and $50 with a copay after the deductible is met. Before the deductible is met, you pay the negotiated rate, which for common generic amphetamine salts may range from $25 to $90 at retail pharmacies, depending on the dispensing pharmacy and Quartz's contracted rate.

GoodRx and similar discount programs are not combinable with insurance at the point of sale. Some patients pay less by using a discount card outside insurance entirely, which is a legitimate strategy for generic stimulants when the out-of-pocket cost is low.

Brand Adderall XR Cost Estimates

Brand-name Adderall XR 20 mg sits at Tier 3 on most Quartz formularies, with retail negotiated costs before deductible often exceeding $300 for a 30-day supply. After deductible, copays at Tier 3 typically range from $40 to $100. Shire (now part of Takeda) has historically offered a savings card for Adderall XR that reduces brand copays for commercially insured patients, though eligibility and availability change; the prescribing pharmacist can check current card validity.

Out-of-Pocket Maximum Protection

All Quartz commercial plans compliant with the Affordable Care Act carry an annual out-of-pocket maximum. For 2025, federal law caps individual out-of-pocket maximums for in-network services at $9,450 for self-only coverage. Once that limit is reached, Quartz pays 100% of covered in-network costs for the remainder of the plan year, including covered prescription drugs.

ADHD Diagnosis Requirements Before Quartz Will Cover Adderall

A valid prescription is necessary but not sufficient for coverage. Quartz's PA process and its clinical coverage policies require that the underlying diagnosis meets accepted diagnostic criteria.

DSM-5 ADHD Criteria

The DSM-5 requires at least six symptoms of inattention or hyperactivity-impulsivity in patients under 17, or at least five symptoms in patients 17 and older, present in two or more settings for at least six months, with onset before age 12. The NIH's MedlinePlus resource on ADHD diagnosis summarizes these criteria and is frequently referenced in insurer clinical policy documents.

Prescriber Qualifications

Quartz generally accepts stimulant prescriptions from primary care physicians, pediatricians, psychiatrists, and licensed nurse practitioners or physician assistants operating within their scope of practice. Some Quartz PA policies require that complex cases (adults with a new ADHD diagnosis after age 40, for example) be evaluated by a psychiatrist or neuropsychologist before PA is approved.

Adult ADHD Coverage Considerations

Adult ADHD coverage has expanded significantly as diagnostic rates have risen. A 2023 analysis published in JAMA Psychiatry estimated that adult ADHD prevalence in the United States may be as high as 4.4% of the adult population. That estimate is grounded in epidemiological data accessible through PubMed. Quartz does not restrict Adderall coverage to pediatric patients, and adult diagnoses supported by appropriate documentation are processed through the same PA pathway.

Alternatives to Adderall That Quartz May Prefer

When Adderall generic is unavailable due to shortage, or when step therapy requires trying a different first-line agent, several alternatives sit at Tier 1 or Tier 2 on most Quartz formularies.

Methylphenidate Products

Generic methylphenidate immediate-release and extended-release (generic Ritalin, generic Concerta, generic Focalin) are frequently Tier 1 preferred generics on Quartz plans. Methylphenidate is a dopamine/norepinephrine reuptake inhibitor rather than a releaser, which gives it a distinct pharmacological profile. Some patients respond better to one class than the other. A trial of methylphenidate may satisfy step therapy requirements before Quartz approves a brand amphetamine product.

Non-Stimulant Options

Atomoxetine (generic Strattera) is a selective norepinephrine reuptake inhibitor approved by the FDA for ADHD in children, adolescents, and adults. It carries no Schedule II restriction and is usually Tier 1 or Tier 2. Viloxazine (Qelbree), approved in 2021, and guanfacine extended-release (generic Intuniv) are additional non-stimulant options that some Quartz plans cover at lower tiers than brand stimulants. The FDA's prescribing information for atomoxetine is available through FDA.gov.

Lisdexamfetamine (Vyvanse)

Vyvanse (lisdexamfetamine) is a prodrug amphetamine approved for ADHD and binge eating disorder. A generic became available in August 2023 after patent exclusivity ended. Generic lisdexamfetamine may be covered at a lower tier than brand Vyvanse on some Quartz plans, making it a reasonable alternative when generic Adderall is unavailable. The FDA approved the first generic lisdexamfetamine in 2023. That approval is documented on the FDA's drug approval database.

How to Get Adderall Covered by Quartz: A Step-by-Step Process

The following framework reflects standard insurer PA workflows applied to Quartz's documented coverage policies and Wisconsin regulatory requirements. Your prescriber's office should own most of these steps, but knowing the sequence helps you move things forward if delays occur.

Step 1. Confirm your diagnosis is documented in your medical record. Your prescriber needs a chart note with DSM-5 criteria, symptom onset, and functional impairment across two settings before submitting any PA.

Step 2. Call Quartz member services (the number on your card) and ask specifically: Is generic amphetamine/dextroamphetamine IR covered on my plan without PA? Is Adderall XR covered, and at what tier? What is the step therapy requirement?

Step 3. Check pharmacy availability. Before your prescriber sends the prescription, call your preferred pharmacy to confirm amphetamine stock given the ongoing FDA shortage.

Step 4. If PA is required, your prescriber submits the PA request through Quartz's online portal or by fax. Quartz is required under federal law to respond to standard PA requests within 72 hours and to urgent requests within 24 hours.

Step 5. If PA is denied, request a peer-to-peer review. Your prescriber speaks directly with the Quartz medical director reviewing the denial. Peer-to-peer reviews reverse denials in a meaningful proportion of cases when documentation is complete.

Step 6. If peer-to-peer fails, file a formal appeal. Under the ACA, you have the right to an internal appeal and, if that fails, an independent external review. Wisconsin's Office of the Commissioner of Insurance oversees external review for state-regulated Quartz plans.

Step 7. If the appeal is upheld against you, ask about a formulary exception. A formulary exception requests that Quartz cover a non-covered or non-preferred drug based on medical necessity. The prescriber must demonstrate that all covered alternatives are contraindicated or have been tried and failed.

Telehealth Prescribing of Adderall and Quartz Coverage

The COVID-era DEA telehealth exemption that allowed Schedule II stimulant prescribing via telemedicine without an in-person visit was extended multiple times. As of early 2025, DEA proposed rules would continue to allow telehealth prescribing of Schedule II substances under specific conditions, including registration with a special telemedicine registry. The DEA's proposed telemedicine rules are summarized on the DEA's official site, with the underlying Federal Register notice accessible through NIH.

Quartz covers telehealth visits for medically necessary services, but the coverage of a telehealth-prescribed stimulant depends on whether the prescription itself complies with applicable DEA rules at the time of dispensing. Prescriptions written through a DEA-compliant telehealth encounter are processed the same as in-person prescriptions by Quartz's pharmacy benefit.

Medicare Advantage and Medicaid Quartz Plans: Different Rules Apply

Quartz offers Medicare Advantage plans in Wisconsin. Medicare Part D, which covers outpatient prescription drugs, does cover Schedule II stimulants including amphetamine/dextroamphetamine, but coverage varies by Part D plan formulary. CMS requires all Medicare Part D plans to cover at least two drugs in every therapeutic category, but does not mandate coverage of every individual amphetamine product.

Quartz Medicaid plans (ForwardHealth in Wisconsin) follow state Medicaid drug coverage policies, which are set by the Wisconsin Department of Health Services rather than Quartz's commercial formulary team. Wisconsin Medicaid does cover amphetamine/dextroamphetamine for ADHD, generally with PA requirements for patients above a certain age threshold.

If you are on a Quartz Medicare Advantage or Medicaid plan, call the plan directly and ask for the pharmacy benefit specifically. The formulary for those plans is distinct from any commercial plan formulary.

Key Statistics on ADHD Medication Use and Insurance Coverage

ADHD stimulant prescriptions are among the most commonly prescribed controlled substances in the United States. The CDC reported that approximately 6.1 million children in the United States had received an ADHD diagnosis as of 2016, with that number continuing to rise. CDC ADHD data is published at CDC.gov.

A 2021 analysis in JAMA found that stimulant use among adults aged 20 to 39 increased by 45% between 2016 and 2021, driven largely by increased diagnosis rates in women and adults. That study is indexed on PubMed.

The American Academy of Child and Adolescent Psychiatry's practice parameter states: "Stimulant medications are the most effective pharmacological treatment for ADHD, with response rates of 70 to 80% in controlled trials." That statement underpins the clinical rationale that most PA reviewers at Quartz and peer insurers use when evaluating ADHD stimulant requests. The AACAP parameters are referenced in PubMed-indexed literature.

A 2020 Cochrane review of methylphenidate for adults with ADHD (N=2,496 across 19 RCTs) found standardized mean differences in ADHD symptoms of 0.49 favoring methylphenidate over placebo, with an absolute response rate difference of roughly 27 percentage points. That Cochrane review is available through the Cochrane Library. Amphetamine products show comparable or slightly larger effect sizes in head-to-head meta-analyses, supporting their clinical equivalence and justifying their formulary inclusion.