Quantity limits are in place to ensure your medication is being used correctly and that you are getting the most appropriate treatment.1
Basic Blue Rx will be accepting Coverage Determination requests for 2019 beginning November 1, 2018.
- Some prescriptions are limited to a specified maximum quantity. Amounts over that quantity are not covered unless approved in advance by the plan.
- Basic Blue Rx covers up to a 30-day supply for retail prescriptions, or up to a 90-day supply at certain retail pharmacies or through mail order.
- Drugs on the specialty tier are limited to a maximum 30 days’ supply.
No special steps are required to have your drugs covered as long as your medications are prescribed within specified limitations.
- If you require drugs in a larger quantity than is allowed your physician may request a coverage exception.
- This type of exception is processed through a coverage determination.
- Request coverage of a quantity in excess of plan quantity limits with the Quantity Limit Exception Fax Form.
- Search the drug list (formulary) to find out if your drug has a quantity limit.
1 Quantity Limits are based on manufacturer's safety and dosing guidelines.