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What are Medicare Part D prescription drug Quantity Limits?


Quantity Limits (QL) are a Medicare Part D plan drug utilization tool limiting the amount of a particular drug that the Medicare Part D plan will cover during a specified time period, such as 30 pills per 30 days.

Like Prior Authorization or Step Therapy, Quantity Limits are a "utilization management restriction" that your Medicare Part D plan can place on medications to manage health or safety concerns.

Your Medicare Part D plan's formulary will show any Quantity Limits for your medications and you can also see the Quantity Limits for all formulary medications by using our Drug Finder (Q1Rx.com) or Formulary Browser (Formulary-Browser.com).

For example, in our Drug Finder or Formulary Browser, we will show "Q:6/28Days" next to a certain drug - meaning the quantity limit for the drug is 6 pills per 28 days -  or if you see "Q:90/365Days" this means that the Medicare Part D plan limits this drug to 90 pills for the entire year.

If your doctor writes you a prescription for a higher quantity 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 a 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 here: https://q1medicare.com/PartD-HowToDrgExceptionAppealComplaint.php

See also:
Where do I get a list of the number of pills I can get at one time?





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