Quantity Limits

About quantity limits

Certain drugs have quantity limits to encourage appropriate drug usage, enhance drug therapy and reduce costs. The quantity limit is the maximum quantity that can be dispensed over a given period of time. Preferred and non-preferred drugs may have quantity limits.

What it means for you

If you’re currently taking more than the maximum quantity limit of a drug, please talk to your doctor. Together you can discuss which medication options are best for you. Your doctor can decide whether to write a new prescription or submit a written request for you to continue your current quantity of medication.

How a quantity limit works

Below is an example:

  1. A member presents a prescription for a drug at the pharmacy.
  2. The pharmacist enters the prescription information into the claim system.
  3. The claim is submitted for processing – the claims system reviews the quantity being requested.
  4. If the quantity is less than or equal to the quantity limit, the claim will automatically process.
  5. If the quantity being requested exceeds the quantity limitation, the pharmacy can fill the prescription up to the quantity limit or you can contact your physician to discuss your options.
  6. If the physician feels that you must receive the original prescribed quantity, the physician will need to submit a quantity limit authorization request.
  7. A notification will be sent to both the member and physician on whether the request has been approved or denied. The review takes approximately five to ten business days.

Refer to utilization management questions to find answers to any questions you may have about this program.

Drug list and request form