This is known as a quantity limit restriction (such as 30/30 days or 30 pills for 30 days). You can review your Medicare Part D plan's
formulary for any
Usage Management Restrictions or to further clarify
the coverage details under your particular Medicare Part D prescription
drug plan. The abbreviations that you might find on your formulary may
include:
PA = Prior Authorization,
PA-NS = Prior Authorization New Starts,
PA-BvsD = Prior Authorization-BvsD Only (Part D vs. Part B Prior Authorization Only),
QL = Quantity Limits,
ST = Step Therapy,
ST-NS = Step Therapy New Starts,
LA = Limited Access,
MS = Mail Service Available
You can also use our online
Formulary Browser to review, not only
quantity limits (QL), but also other drug usage management requirements such as
prior authorization (PA) and
step-therapy (ST). Our
Formulary Browser also shows the drug tier and cost-sharing for a 30-day supply and a 90-day mail-order supply. You can click on the cost-sharing value (or Rx$ icon by the plan name) to see the cost-sharing for all phases of coverage and pharmacy types. Here is an example for the
AARP Saver Plan Formulary in Arizona.
If your prescription is for a quantity higher than your medication's quantity limit, you can request a
formulary exception with your prescribing
physician's assistance to have the quantity limit for your medication increased.
If your request is denied by your Medicare Part D plan, there are
5 levels of appeals that you can go through to get the quantity limit for your medication increased.