Frequently Asked Questions about Drug Usage Restrictions (QL, PA, ST)

May, 24 2024 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Jun, 28 2023 — Most Medicare Part D plans will have Prior Authorization forms online that you can download, print, and take with you to your doctor (or other prescriber) so that they can offer assistance completing . . .

Oct, 23 2023 — Step Therapy is a utilization management restriction that your Medicare Part D prescription drug plan can add to a formulary medication. According to the Centers for Medicare and Medicaid (CMS) "St . . .

Jun, 28 2023 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Jun, 24 2024 — You can get a 30-day temporary or transition prescription drug fill if you: stayed with the same Medicare Part D prescription drug plan (or Medicare Advantage plan that includes drug coverage) . . .

Jun, 25 2024 — Quantity Limits (QL) are a Medicare Part D plan drug "utilization management restriction" which limits the amount of a particular formulary drug that the Medicare Part D plan will cover during a spec . . .

Jul, 09 2023 — Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ acces . . .

Jan, 04 2024 — A transition fill is a temporary 30-day prescription supply or refill of a non-formulary drug provided to: People who have stayed with the same Medicare drug plan into the next year and now fi . . .

Jun, 24 2024 — A Quantity Limitation (Quantity Limit), according to the Centers for Medicare and Medicaid (CMS) is defined as: For safety and cost reasons, plans may limit the quantity of drugs that they cover ov . . .

Oct, 29 2023 — If your pharmacist tells you that one of your Medicare Part D prescription drugs requires prior authorization (PA), you should contact your Medicare Part D plan to find out about the PA requirement an . . .

Sep, 01 2022 — This is known as a quantity limit restriction (such as 30/30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to furt . . .

May, 04 2023 — Indication-based utilization management (or indication limitations) is a type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan's prior authoriz . . .

Jul, 28 2023 — Medicare Part D plans can change formulary or drug list designs each year and your Medicare prescription drug plan may have implemented utilization management (or drug usage management) restrictions i . . .

Apr, 20 2024 — Yes, but the change may not affect you this year.  As you may know, your Medicare Part D plan’s formulary can change in a number of ways throughout the plan-year, including the addition of . . .

Aug, 09 2019 — You may be paying full retail cost for your generic medications for a few reasons: You could be in the deductible phase of your Medicare Part D coverage and you are responsible for 100% of you . . .

Jan, 23 2023 — Yes.  According to the Centers for Medicare and Medicaid Services (CMS), the transition fill policy will apply to both non-formulary Part D drugs and “Part D drugs that are on a sponso . . .

Jun, 25 2024 — Quantity Limits (QL) are a Medicare Part D plan drug "utilization management restriction" which limits the amount of a particular formulary drug that the Medicare Part D plan will cover during a spec . . .

Jun, 24 2024 — A Quantity Limitation (Quantity Limit), according to the Centers for Medicare and Medicaid (CMS) is defined as: For safety and cost reasons, plans may limit the quantity of drugs that they cover ov . . .

Jun, 24 2024 — You can get a 30-day temporary or transition prescription drug fill if you: stayed with the same Medicare Part D prescription drug plan (or Medicare Advantage plan that includes drug coverage) . . .

May, 24 2024 — Utilization management restrictions (or "usage management" or "drug restrictions") are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs a . . .

Apr, 20 2024 — Yes, but the change may not affect you this year.  As you may know, your Medicare Part D plan’s formulary can change in a number of ways throughout the plan-year, including the addition of . . .

Jan, 04 2024 — A transition fill is a temporary 30-day prescription supply or refill of a non-formulary drug provided to: People who have stayed with the same Medicare drug plan into the next year and now fi . . .

Oct, 29 2023 — If your pharmacist tells you that one of your Medicare Part D prescription drugs requires prior authorization (PA), you should contact your Medicare Part D plan to find out about the PA requirement an . . .

Oct, 23 2023 — Step Therapy is a utilization management restriction that your Medicare Part D prescription drug plan can add to a formulary medication. According to the Centers for Medicare and Medicaid (CMS) "St . . .

Jul, 28 2023 — Medicare Part D plans can change formulary or drug list designs each year and your Medicare prescription drug plan may have implemented utilization management (or drug usage management) restrictions i . . .

Jul, 09 2023 — Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ acces . . .

Jun, 28 2023 — Some medications are carefully monitored by Medicare Part D plans to ensure your safety and your plan may require that you receive prior approval or "prior authorization" before your prescription will . . .

Jun, 28 2023 — Most Medicare Part D plans will have Prior Authorization forms online that you can download, print, and take with you to your doctor (or other prescriber) so that they can offer assistance completing . . .

May, 04 2023 — Indication-based utilization management (or indication limitations) is a type of utilization management that a Medicare Part D prescription drug plan can implement along with the plan's prior authoriz . . .

Jan, 23 2023 — Yes.  According to the Centers for Medicare and Medicaid Services (CMS), the transition fill policy will apply to both non-formulary Part D drugs and “Part D drugs that are on a sponso . . .

Sep, 01 2022 — This is known as a quantity limit restriction (such as 30/30 days or 30 pills for 30 days).  You can review your Medicare Part D plan's formulary for any Usage Management Restrictions or to furt . . .

Aug, 09 2019 — You may be paying full retail cost for your generic medications for a few reasons: You could be in the deductible phase of your Medicare Part D coverage and you are responsible for 100% of you . . .