HealthChoice Medicare Supplement Plans With Part D
Medications with Quantity Limits
Due to approved therapy guidelines the following medications have set maximum quantity limits per copay. These quantity limits are less than the standard pharmacy benefit of a 30-day or 90-day supply. Quantity limits are determined by the recommended length of therapy and/or routine use of the medication and also apply when the medication form is other than a tablet or capsule.
New medications that become available in the drug categories listed below will automatically have quantity limits per copay. New drug categories may be added throughout the year. If a generic equivalent of one of these medications is available, the quantity limit will also apply.
Be aware that non-formulary medications that have been approved for coverage by a prior authorization, may also be limited in quantity.
If you have questions about medications with quantity limits, please contact Express Scripts at the following numbers:
Members with Part D call toll-free 1-800-590-6828.
TDD users call toll-free 1-800-716-3231.
Members without Part D call toll-free 1-800-903-8113.
TDD users call toll-free 1-800-825-1230.
This is a list of the categories that have some or all medications that are limited in quantity. The medication(s) in these categories are alphabetically listed below.
Please note that this list may not be all-inclusive and is subject to change.
Erectile Dysfunction/Impotence Agents
Migraine Therapy Drugs
Miscellaneous Gastrointestinal Agents
Miscellaneous Neurological Therapies
Multiple Sclerosis Therapy Drugs
Ophthalmic Therapy Drugs - Miscellaneous
Osteoporosis Therapy Drugs
Rheumatoid Arthritis Therapy Drugs
Tobacco Cessation Drugs