Quantity Limits

Safety is Our Priority

New medications and new drug information come to the market at an astounding pace. Additionally, a record number of drugs have been taken off the market because of safety issues that were identified after marketing.

In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization, step therapy and quantity limits on selected prescription medications.

For certain prescription drugs, we have additional requirements for coverage or limits on coverage. These requirements and limits ensure our members use these drugs in the safest, most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our Plan to help us provide quality coverage for our members.

Quantity Limits

For certain drugs, we limit the amount of the drug that we will cover. For example, we provide 60 tablets per 30-day supply for ENTRESTO. The same quantity limits requirements apply to both mail order and retail pharmacies.

Drugs that have quantity limits are indicated on our drug list.

Requesting an Exception

For patients who require higher doses for medical purposes, an exception process is in place. Your doctor must complete the exception process demonstrating that you meet medical criteria. Follow this link to learn more about Requesting an Exception.

For information on the status of your exception request, call Customer Care toll-free at 1-877-883-9577 (TTY/TDD 1-800-662-1220) 8 a.m. to 8 p.m., Monday - Friday, 9:00 a.m. to 1:00 p.m. Saturday. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. to 8 p.m.