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Quantity Limits

For safety and cost reasons, plans may limit the amount of drugs that they cover over a certain period of time. For example, most people who are prescribed heartburn medication take 1 tablet per day for 4 weeks. Therefore, a plan may cover only an initial 30-day supply of heartburn medication. Should you need more medication, you may need your doctor’s help in providing more information for a refill.

If your doctor believes that because of your medical condition a quantity limit isn’t medically appropriate for you, you or your doctor can contact the plan to request an exception. If the request is approved, the quantity limit won’t apply to your drug.



(Primary Source: Centers for Medicare and Medicaid Services - Your Guide to Medicare Prescription Drug Coverage 2008. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)


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