Skip to main content

This website is not compatible with Internet Explorer. Experiencing Difficulties? Please try a different browser.

Maintenance Drugs and Quantity Limits

Maintenance Drugs

Many maintenance medications can be processed for a 90-day supply without the need for an override.

Maintenance Drug List

Quantity Limits

The medication listed below are subject to specific quantity limits. These quantity limits may be in addition to step therapy or prior authorization requirements. Quantity limits apply to both brand and generic versions of the medication unless otherwise specified. Exceptions to the quantity limits may be approved by the Pharmacy Help Desk when clinical circumstance warrant. Please call 1-800-522-0114, option 4.

PHARM-13 Statement of Medical Necessity for Quantity Limits Override

Last Modified on Jun 01, 2022
Back to Top