Some drugs have quantity limits to help encourage appropriate usage, ensure effectiveness and reduce costs. The quantity limit is the maximum amount of a drug that can be dispensed over a given period of time. Both preferred and non-preferred drugs may have quantity limits.
What it means for you
If you’re now taking more than the maximum 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 written request for you to continue your current quantity.
How a quantity limit works
Here's an example:
1. You present a prescription for a drug at the pharmacy.
2. The pharmacist enters the information into the claim system and it reviews the quantity requested.
3. If the quantity is less than or equal to the quantity limit, the claim is automatically processed.
4. If the quantity requested is over the quantity limit, the pharmacy can fill the prescription up to the limit or you can contact your doctor to discuss your options.
5. If your doctor feels that you must receive the original prescribed quantity, they will need to submit a quantity limit authorization request.
6. A notice will be sent to both you and your doctor to let you know if the request has been approved or denied. The review takes about five to ten business days.
Refer to the FAQ section of this site for any questions you may have about this program.
FlexRx and GenRx drug lists — Quantity limits for FlexRx and GenRx formulary. The list may change without notice.
Request for prescription drug coverage exception — You or your doctor may complete this form to start a quantity limit override request.