Understanding Quantity Limits

Why have I received this information?

This information has been prepared for you by Anthem Prescription Management, your pharmacy benefit manager. From time to time, your physician may prescribe a medication that is subject to a quantity limit. We think you will find this information helpful, in case you need a medication requiring a quantity limit.


What is a quantity limit?

A quantity limit is a restriction on the amount of a medication for which you can obtain benefits during a specific period of time. Most often, a quantity limit is set on a monthly basis.

Which medications have a quantity limit?

Medication Quantity Limit
Accutane® No refills allowed. No mail service for this drug.
Aciphex 30 tablets per 30 days
Actonel 4 tablets 35mg
30 tablets 5mg or 30mg
Actos 30 tablets per 30 days
Advair 1 inhaler/30 days (60)
Aerobid®/Aerobid M® inhaler 3 inhalers per 30 days
Alamast™ 1 bottle per month
Aldara™ 12 packets per 28 days
Allegra 30 tablets 180mg per 30 days
60 tablets 30mg or 60mg per 30 days
Allegra D 30 tablets 180mg/240mg per 30 days
60 tablets 60mg/120mg per 30 days
Alocril™ 1 bottle per month
Alomide® 1 bottle per month
Alupent® inhaler 3 inhalers per 30 days
Ambien CR 30 tablets per 30 days
Amerge® 9 tablets per 30 days
Androderm 60 patches 2.5mg per 30 days
30 patches 5mg per 30 days
AndroGel 60 packets 2.5gm per 30 days
30 packets 5gm per 30 days
2 units of the pumps
Anzemet 50mg tablets 10 tablets per 30 days
Anzemet 100mg tablets 5 tablets per 30 days
Asmanex 1 inhaler per month
Atrovent® .03% nasal spray 2 bottles per 30 days
Atrovent® .06% nasal spray 3 bottles per 30 days
Atrovent® nebulizer solution 150 unit dose vials (2.5ml ea.) per 30 days
Atrovent® inhaler 3 inhalers per 30 days
Augmentin tablets; suspension 60 days every 3 months
Avandamet 120 tablets 1/500 and 2/500mg
60 tablets 2/1000, 4/500, and 4/1000mg
Avandia 60 tablets 2mg or 4mg
30 tablets 8mg
Axert™ 6 tablets per 30 days
Azmacort® 2 inhalers per 30 days
Beconase AQ® nasal inhaler 2 inhalers per 30 days
Boniva® 2.5mg 1 per day
Boniva® 150mg 1 per 28 days
Ceftin® tablets and suspension 60 days every 3 months
Celebrex® 100mg 120 capsules per 30 days
Celebrex®200mg 60 capsules per 30 days.
Celebrex® 400mg 30 capsules per 30 days.
Celexa® 10mg, 20mg Daily dose 1 per day
Clarinex® 30 tablets per 30 days
300 mLs syrup per 30 days
Clarinex D 30 tablets/30 days
Combivent® inhaler 3 inhalers per 30 days
Crolom® 1 bottle per month
Diflucan® 150mg tablets 2 tablets per 30 days
Elestat 1 bottle per month
Emadine® 1 bottle per month
Emend® 80mg 8 capsules per 30 days
Emend® 125mg 4 capsules per 30 days
Emend® therapy pack 4 Packs (12 capsules) per 30 days
Enbrel™ 8 vials 25mg every 28 days
4 vials 50mg every 28 days
Flonase® 1 inhaler per 30 days
Flovent 110® inhaler 1 inhaler (13gm) per 30 days
Flovent 44® inhaler 1 inhaler (13gm) per 30 days
Flovent 220® inhaler 2 inhalers (13gm) per 30 days
Flovent Rotadisk® 50 mcg/100mcg 1 inhaler per 30 days
Flovent Rotadisk® 250mcg 4 inhalers per 30 days
Foradil® 2 inhalers per 30 days
Forteo 1 pen per 30 days
Fosamax 4 tablets 35mg or 70mg
30 tablets 5mg, 10mg, or 40mg
Fosamax Plus D 4 per 28 days
Frova™ 9 tablets per 30 days
Humira® 2 vials every 28 days
Imitrex® injection 4 injections per 30 days
Imitrex® nasal inhaler 6 nasal inhalers per 30 days
Imitrex® tablets 9 tablets per 30 days
Kytril® 1mg tablets 8 tablets per 30 days
Kytril® susp 40ml per 30 days
Livostin® 1 bottle per month
Lortab® 10 8 tablets per day
Lunesta 30 tablets per 30 days
Maxair Autohaler™ 2 inhalers per 30 days
Maxalt® tablets 12 tablets per 30 days
Maxalt-MLT™ tablet 12 tablets per 30 days
Miacalcin nasal spray 1 bottle (3.7 mL) per 30 days
Migranal® nasal inhaler 1 kit = 6 canisters per 30 days
Nasacort AQ® nasal inhaler 1 inhaler per 30 days
Nasarel® nasal inhaler 3 inhalers per 30 days
Nasonex® nasal inhaler 1 inhaler per 30 days
Nexium 30 capsules per 30 days
Opticrom® 1 bottle per month
Optivar™ 1 bottle per month
Patanol® 1 bottle per month
Plan B® 2 kits per 30 days, 1 copay per kit
Prevacid Capsules 30 capsules per 30 days
Preven™ kit 2 kits per 30 days, 1 copay per kit
Prilosec® 40mg (omeprazole) 30 capsules per 30 days
Primaxin® injection 30 days every 3 months
Protonix 30 tablets per 30 days
Proventil® (albuterol) 3 inhalers per 30 days
Provigil® 200mg per day
Pulmicort® inhaler 1 inhaler per 25 days
Pulmicort® respules 2 boxes per 30 days
QVAR inhaler™ 3 inhalers per 30 days
Relenza® inhaler 1 carton (5-day supply) per member per prescription and 2 per year.
Age 7 and older.
No mail service for this drug.
Relpax® 6 tablets per 30 days
Revatio 90 tablets per month (3 per day)
Rhinocort Aqua™ nasal inhaler 2 inhalers per 30 days
Rocephin® injection 30 days every 3 months
Rozerem 30 tablets per 30 days
Serevent Diskus® (28 & 60 each) 28 each- 3 inhalers per month
60 each- 2 inhalers per month
Singulair 30 units per 30 days
Spiriva® 1 inhaler per 30 days
Stadol nasal spray® 1 bottle per 30 days
Suprax® 60 days every 3 months
Tamiflu™ 1 package per member per prescription fill and 2 packages per year. Age 1 and older. No mail service for this drug.
Testim® 30 tubes per 30 days
Toradol® injections 60 mg/30 days
Toradol® tablets 20 tablets per 30 days
Ventolin® (albuterol) 3 inhalers per 30 days
30 tablets per 30 days
Zaditor® 1 bottle per month
Zetia 30 tablets per 30 days
Zithromax® 1 gram granules 2 packets per fill
Zithromax® 100mg/5ml suspension 75ml per fill
Zithromax® 200mg/5ml suspension 37.5ml per fill
Zithromax® 250mg tablets 6 tablets per fill, 5 day therapy
Zithromax® 500mg tablets 3 tablets per fill
Zithromax® 600mg tablets 8 tablets per 30 days
ZMax 1 packet per fill
Zofran® /Zofran® ODT™ 4mg tablets 48 tablets per 30 days
Zofran® /Zofran® ODT™ 8mg tablets 24 tablets per 30 days
Zofran® 24mg tablets 8 tablets per 30 days
Zofran® Susp 240ml per 30 days
Zomig® nasal spray 6 inhaler per 30 days
Zomig® tablets 6 tablets per 30 days
Zyrtec, Zyrtec-D 30 tablets 5mg, 10mg (including chewables) per 30 days
60 tablets Zyrtec-D
300 mLs syrup per 30 days

What should I do if I require an increased quantity?

Ask your pharmacist to contact Anthem Prescription at 1 (800) 662-0210. Customer service hours are: Monday through Friday, 8:30 a.m. to 12 a.m. (EST); Saturday, 9 a.m. to 7 p.m. (EST); and Sunday, 9 a.m. to 5 p.m. (EST).When your pharmacist calls, they will need to have the following information:

APPROVED: If the benefit criteria are met, the customer service representative will enter an authorization to allow your claim to process immediately.

MORE INFO NEEDED: If more information is needed, Anthem Prescription may contact your physician. Once the relevant information is received from your doctor, an Anthem Prescription pharmacist will review the information based upon the health plan approved benefit criteria. If the benefit approval criteria are met, the authorization will be approved.

If the review concludes that the benefit criteria have not been met, the claim will be sent to your health plan for review. If the health plan finds that the benefit requirements are not satisfied, the claim will be denied by your health plan.

Please Note: Due to varying health benefit plans, inclusion of a drug and related items on the drug list/formulary is not a guarantee of coverage. Please refer to your prescription drug benefit description of coverage, limitations and exclusions.