Quantity limits are in place to ensure your medication is being used correctly and that you are getting the most appropriate treatment.*
- Some prescriptions are limited to a specified maximum quantity. Amounts over that quantity are not covered unless approved in advance by the plan.
- Blue MedicareRx covers up to a 30-day supply for retail prescriptions, or up to a 90-day supply at certain retail pharmacies or through mail order.
No special steps are necessary by a physician or member to have your drugs covered as long as your medications are prescribed within specified limitations.
- If you require drugs in a larger quantity than is allowed your physician may request a coverage exception.
- This type of exception is processed through a coverage determination.
- Coverage Determination: Use the online form or printable version if this is your first coverage request for a drug and you want to submit it online.
- Coverage Redetermination: Use the online form or printable version if you are appealing a previously denied request and you want to submit it online.
- Quantity Limit Exception Fax Form
- Request coverage of a quantity in excess of plan quantity limits
Search the drug list (formulary) to find out if your drug has a quantity limit.
* Quantity Limits are based on manufacturer's safety and dosing guidelines