Some of my medications are now subject to Quantity Limits, Prior Authorization, and Step Therapy. What does this mean?

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 in their formulary to keep costs down and protect their plan members.

Utilization management includes such prescription controls as Quantity Limits (for example, only allowing plan members 30 tablets per 30 days) or Prior Authorization (requiring members to get plan approval before filling a prescription) or Step Therapy (having members try lower-costing medications before using a more expensive drug).

Utilization management restrictions can be applied to formulary drugs provided by stand-alone Medicare Part D plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs)

If your prescription drug is no longer covered due to a newly imposed usage or utilization management restriction, you can ask your Medicare prescription drug plan for a one-time 30-day transition or temporary supply while you and your prescribing physician work to satisfy the usage management requirement or find another formulary drug. You can click here to read more about transition fills.

Please remember, you always have the right to ask your plan for a formulary exception if you wish to be exempted from a specific usage management requirement. Click here to learn how to request a formulary exception.

If the restriction is added mid plan-year, you may not be subject to the restriction.

Reminder: Both our Formulary Browser (showing all drugs for a single Medicare plan) and our the drug finder® Drug Finder ( on this site - showing all Medicare plans covering a single drug) display the details of the drug utilization management requirements along with the drug cost-sharing information for all Medicare Part D plans and Medicare Advantage plans.