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Quantity Limits

Quantity Limits: Applied to certain drugs based on the approved dosing limits established during the FDA approval process. Quantity limits are applied to the number of units dispensed for each prescription. If your health plan's formulary guide reflects that there is a Quantity Limit for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. To obtain the correct form, select the appropriate drug below and follow the instructions at the top of the form. You can search this page by usingthe search function within your application. (Press Ctrl+F on Windows or Command+F on Mac to bring up the search bar).

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Quantity Limits © Prime Therapeutics LLC