Quantity Limits (QL) are a Medicare Part D plan drug "utilization management restriction" which control the amount of a particular formulary drug that the Medicare Part D plan will cover during a specified time period. For example, your Medicare drug plan may state that a particular drug is limited to 30 pills per 30 days.
Like Prior Authorization (PA) or Step Therapy (ST), Quantity Limits are used by your Medicare Part D plan to manage plan members' health and medication safety.
What if you do not agree with your Medicare drug plan's Quantity Limit?
If your doctor writes a prescription for a quantity higher than your Medicare Part D plan's quantity limit, you can request a formulary exception from your drug plan - and, with your prescribing physician's assistance, ask your plan to cover the quantity of medication that is higher than the plan's quantity limit.
A formulary exception request is not automatically granted and if your Medicare Part D plan denies your request, you can appeal the Medicare plan's negative decision. You can read more about appealing your Medicare Part D plan's decision on this site
See also:
Where do I get a list of the number of pills I can get at one time?
Like Prior Authorization (PA) or Step Therapy (ST), Quantity Limits are used by your Medicare Part D plan to manage plan members' health and medication safety.
Your Medicare Part D plan's formulary will show any Quantity Limits for your medications and you can also see the Quantity Limits and any other utilization management restrictions for all formulary medications by using our Drug Finder or Formulary Browser (Formulary-Browser.com).
The notation we show include in our Formulary Browser is:
The notation we show include in our Formulary Browser is:
- Q -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.
- P -This drug is subject to prior authorization.
- S -This drug is subject to step therapy.
- None - This drug does not fall under any drug utilization management controls
What if you do not agree with your Medicare drug plan's Quantity Limit?
If your doctor writes a prescription for a quantity higher than your Medicare Part D plan's quantity limit, you can request a formulary exception from your drug plan - and, with your prescribing physician's assistance, ask your plan to cover the quantity of medication that is higher than the plan's quantity limit.
A formulary exception request is not automatically granted and if your Medicare Part D plan denies your request, you can appeal the Medicare plan's negative decision. You can read more about appealing your Medicare Part D plan's decision on this site
See also:
Where do I get a list of the number of pills I can get at one time?
- Browse Medicare Part D prescription drug plans
- Browse Medicare Advantage plans (MAPD)
- Sign-up for our Medicare Part D Newsletter.
- Still have a question? Click here to let us know.