Quantity limits drug program

A quantity limit is the highest amount of a prescription drug that can be given to you by your pharmacy in a period of time (for example, 30 tablets per month). Some drugs have quantity limits to help encourage appropriate usage, ensure effectiveness and reduce costs. Both preferred and non-preferred drugs may have quantity limits. 

What it means for you 

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

Does my drug have a quantity limit?

Check your covered drug list to see the quantity limit for your drug. (You'll need to know the name of your drug list and choose it from a dropdown menu for this search.) You can find the name of your drug list in your health plan materials or by calling customer service. You can also log in to your member site to search your drug list.

Search drug list

How a quantity limit works 

When you give a prescription to your pharmacist, the pharmacy's system will review the quantity requested. If the quantity prescribed is less than or equal to the quantity limit, your prescription is filled and the claim is automatically processed.

What to do if the quantity is over the limit: 

The pharmacy can fill the prescription up to the limit

OR 

You can contact your doctor to discuss your options

If your doctor feels you must receive the original prescribed quantity, your or your doctor will need to submit the online request below for an exception to the quantity limit.

Then, you and your doctor will receive a notice to let you know if the request has been approved or denied. The review takes about five to ten business days.

Request drug coverage exception