Drug Quantity Limits Quantity limits (QL) on medications are established to maximize the dosing regimen and decrease cost
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1 Drug Quantity Limits Quantity limits (QL) on medications are established to maximize the dosing regimen and decrease cost QLs are commonly placed on once daily drugs available in multiple strengths. The limit allows for titration to an effective dose, but requires long-term use with an appropriate strength of the medication. Taking medications less often (10mg once daily versus 5mg twice daily, if appropriate) increases compliance. If generics are added for BRAND drugs with QLs, the generic will have the same QL Abilify Astelin 2 bottles per month Abilify Discmelt Astepro 2 bottles per month Abilify oral solution 25 ml per day Atacand 4mg & 32mg acarbose 100mg 3 tablets per day Atacand 16mg acarbose 25mg 1 Atacand 8mg 3 tablets per day acarbose 50mg Atacand HCT mg Atacand HCT mg Accolate & 32-25mg Actonel 5mg & 30mg Avalide mg Actonel 150mg 1 tablet per month Avalide mg. & mg Actonel 35mg 4 tablets per month Avandamet Actoplus Met 3 tablets per day Avandaryl Actos Avandia 2mg 3 tablets per day Adcirca Avandia 4mg Adderall XR 20mg, 25mg & 30mg Avandia 8mg Adderall XR 5mg, 10mg & 15mg Avapro 150mg Advair Diskus 2 blisters per day Avapro 300mg Advair HFA 1 inhaler per month Avapro 75mg 3 tablets per day Advicor 1,000mg- 20mg,500mg-20mg, 750mg- 20mg Avodart Advicor 1,000mg-40mg Avonex 1 kit per month Aerobid-M 3 inhalers per month Axert 12 tablets per month Aggrenox azelastine nasal spray 2 bottles per month Allegra 10 ml per day Azor Allegra-D 12-Hour Beconase AQ 2 bottles per month Allegra-D 24-Hour Benicar 20mg Altoprev Benicar 5mg & 40mg Alvesco 2 inhalers per month Benicar HCT Amitiza Betaseron 14 vials per month amphetamine/dextroampheta mine Boniva 1 tablet per month Anzemet 100mg 3 tablets or a 3 day Boniva Injection 1 syringe per 3 months Anzemet 50mg 6 tablets or a 3 day budeprion sr 100mg 12-4 tablets per day Apriso 4 tablets per day budeprion sr 150mg 12- Aranesp 500mcg/ml 1 syringe per 3 weeks budeprion xl 150mg 24-3 tablets per day Aranesp syringes 4 syringes per month budeprion xl 300mg 24- Aranesp vials 4 vials per month buprenorphine 2mg 16 tablets per prescription Arixtra 1 syringe per day buprenorphine 8mg 8 tablets per prescription Asmanex 1 inhaler per month buproban
2 bupropion 100mg 4 tablets per day dexmethylphenidate bupropion 75mg 3 tablets per day dextroamphetamine 10mg bupropion sr 100mg 12-hour 4 tablets per day dextroamphetamine 5mg bupropion sr 150mg & 200mg 12-hour 10mg 5 capsules per day butorphanol 2 bottles per prescription 15mg 4 capsules per day Byetta 1 pen per month 5mg Bystolic 10mg 4 tablets per day dihydroergotamine 24 ampules per month Bystolic 2.5mg Dilaudid 160 ml per day Bystolic 20mg diltiazem er 180mg 3 tablets per day Bystolic 5mg 3 tablets per day diltiazem er 240mg Caduet diltiazem er 300mg, 360mg & 420mg calcitonin nasal spray 1 bottle per month Diovan 320mg Cardene SR Diovan 40mg, 80mg & 160mg Diovan HCT mg, mg, & 80- Cardura XL 12.5mg Celebrex 50mg, 200mg & 400mg Diovan HCT mg, & mg Celebrex 100mg 3 capsules per day Divigel 2 packets per day cetirizine 10 ml per day dorzolamide 1 bottle per month Chantix 0.5mg & 1mg dorzolamide/timolol 1 bottle per month Chantix Pak 53 tablets per prescription dronabinol 10mg chlorpropamide 100mg 7 tablets per day dronabinol 2.5mg & 5mg 6 capsules per day chlorpropamide 250 mg 3 tablets per day Duetact Clarinex Syrup 10 ml per day Dynacirc CR 10mg Clarinex Tablet & Reditabs Dynacirc CR 5mg 3 tablets per day Clarinex-D 12-Hour Effient Clarinex-D 24-Hour Eligard 22.5mg 1 kit per 3 months clonidine patch 0.2mg & 0.3mg 2 patches per 7 days Eligard 30mg 1 kit per 4 months clonidine patch 0.1mg 1 patch per 7 days Eligard 45mg 1 kit per 6 months Colcrys 4 tablets per day Eligard 7.5mg 1 kit per month Concerta 18mg, 27mg & 54mg CR Emend 40mg 1 capsule per prescription Concerta 36mg CR Emend 80mg & 125mg 2 capsules per prescription Copaxone 1 kit per month Emend Tripak 6 capsules per prescription Covera-HS 180mg 3 tablets per day Emsam 1 patch per day Covera-HS 240mg Enablex Crestor Enbrel 25mg 4 syringes per month Daytrana 1 patch per day Enbrel 25mg/0.5ml & 50mg/ml 8 syringes per month Detrol Ergomar 20 tablets per month Detrol LA ergotamine/caffeine 40 tablets per month Dexilant
3 Estring 1 ring per 3 months glipizide er 2.5mg Estrogel 1 bottle per month glipizide er 5mg 4 tablets per day Evista glipizide/metformin mg & 5-500mg 4 tablets per day Exforge mg, mg, 5-320mg glipizide/metformin mg Exforge 5-160mg Glumetza 4 tablets per day Exforge HCT glyburide 1.25mg 1 Fanapt glyburide 2.5mg Fanapt Titration Pack 1 packet per month glyburide 5mg 4 tablets per day Femring 1 ring per 3 months 1.5mg fentanyl oral lozenge 4 lozenges per day 3mg 4 tablets per day fentanyl patch 12mcg, 25mcg,& 50mcg 15 patches per month 6mg fentanyl patch 75mch & 100mcg 31 patches per month glyburide/metformin mg Firmagon 120mg 2 vials per month glyburide/metformin mg & 5-500mg 4 tablets per day Firmagon 80mg 1 vial per month glycron 1.5mg Flovent HFA 2 inhalers per month glycron 3mg 4 tablets per day fluoxetine dr cap 90mg 4 capsules per month glycron 6mg Focalin XR 20mg Glyset 3 tablets per day Focalin XR 5mg, 10mg,& 15mg granisetron 6 tablets or a 3 days supply Foradil Aerolizer granisol 30 ml or a 3 days supply Fortamet 1000mg Halflytely Bowel Prep 1 per prescription Fortamet 500mg 5 tablets per day Helidac 1 kit per 6 months Fortical 1 bottle per month Humira 20mg 1 kit per month Fosamax Oral Solution 5 bottles per month Humira 40mg 2 kits per month Fosamax Plus D 4 tablets per month Humira Pen 1 kit per month Fragmin 2,500U & 5000U 2 syringes per day hydromorphone 1 Fragmin 25,000U 1 vial per day Imitrex 6 devices per month Fragmin 7500U & 10000U 1 syringe per day Intron-A 4 syringes per month Frova 18 tablets per month Invega Sustenna 1 syringe per month gavilyte-g 1 per prescription itraconazole 130 capsules per month gavilyte-n/flavor pack 1 per prescription Janumet Gelnique 1 pack per day Januvia Genotropin Miniquick 1 cartridge per day Kadian 100mg & 200mg 6 capsules per day Kadian 10mg, 20mg, 30mg, 50mg, 60mg, & glimepiride 1mg 80mg 4 capsules per day glimepiride 2mg 4 tablets per day Kaletra mg glimepiride 4mg Kaletra mg 4 tablets per day glipizide 10mg 4 tablets per day Kaletra Oral Solution 13 ml per day glipizide 5mg ketorolac 4 tablets per day up to 5 days glipizide er 10mg ketorolac 30mg injection 20 ml per month
4 ketorolac 15mg injection 40 ml per month methadose Kineret 1 syringe per day methylin 3 tablets per day lansoprazole Methylin 10mg Chewable Lescol 20mg Methylin 10mg/5ml Oral Solution 30 ml per day Lescol 40mg Methylin 2.5mg & 5mg Chewable 3 tablets per day Lescol XL Methylin 5mg/5ml Oral Solution 60 ml per day Levitra 5 tablets per month methylin er 3 tablets per day levorphanol 1 methylphenidate 3 tablets per day Lidoderm 3 patches per day methylphenidate sr 3 tablets per day Lipitor Miacalcin 1 bottle per month losartan 100mg Micardis losartan 25mg, & 50mg Micardis HCT losartan/hct mg & mg migergot 20 suppositories per month losartan/hct mg Migranal 1 kit per month Lotrel morphine er 100mg & 200mg Lotronex morphine er 15mg, 30mg, 60mg 4 tablets per day Lovenox 2 syringes per day morphine sulfate 1 Lovenox 300mg/3ml only 1 vial per day naratriptan 9 tablets per month Lumigan 2 bottles 5 ml per month Nasacort AQ 1 bottle per month Lunesta Nasonex 2 bottles per month Lupron Depot 11.25mg & 22.5mg 1 kit per 3 months nateglinide 3 tablets per day Lupron Depot 3.75mg & 7.5mg 1 kit per month Nexium Lupron Depot 30mg 1 kit per 4 months Nexium Pack 2 packets per day Maxalt 12 tablets per month Nicotrol Inhaler 18 inhalers per 6 months Maxalt-MLT 12 tablets per month Nicotrol NS 720 ml per 6 months meperidine 1 nisoldipine er 8.5mg, 17mg, 25.5mg, & 34mg meperidine oral solution 240 ml per day Nulytely/Flavor Packs 1 bottle per prescription octreotide 100mcg/ml, Metadate CD 10mg, & 30mg 200mcg/ml, & 50mcg/ml 4 ml per day Metadate CD 20mg 3 capsules per day octreotide 500mcg/ml 3 ml per day Metadate CD 40mg, 50mg, & 60mg omeprazole metformin er 750mg ondansetron 24mg 3 tablets or a 3 days supply ondansetron oral metformin 1000mg solution 100 ml or a 3 days supply metformin 500mg 5 tablets per day ondansetron 4mg & 8mg 9 tablets or a 3 days supply metformin 850mg 3 tablets per day ondansetron odt 9 tablets or a 3 days supply metformin er 500mg 4 tablets per day Onglyza methadone Opana ER 4 tablets per day methadone concentrate 24 ml per day oxandrolone 10mg methadone oral solution 60 ml per day oxandrolone 2.5mg 4 tablets per day
5 oxycodone 1 Strattera 10mg, 18mg, 25mg, & 40mg Oxytrol 2 patches per 7 days Strattera 60mg. 80mg & 100mg pantoprazole Suboxone 3 tablets per day paroxetine er 12.5mg sumatriptan 9 tablets per month paroxetine er 25mg 3 tablets per day sumatriptan injection 8 doses per month paroxetine er 37.5mg Symbicort 1 inhaler per month Patanase 1 bottle per month Symlin 1000mcg/ml 4 pens per month Plavix 300mg 3 tablets per prescription Symlin 600mcg/ml 4 vials per month Plavix 75mg tacrolimus 0.5mg Prandin 0.5mg, & 1mg 4 tablets per day tacrolimus 1mg 8 capsules per day Prandin 2mg Tamiflu 30mg 62 capsules per month Prevpac 14 day pack per 6 months Tamiflu 45mg & 75mg 31 capsules per month Prezista Tamiflu Susp 6 bottles month Pristiq tamsulosin Procrit 2,000U 15 ml per month Tekturna Procrit 10,000U & 20,000U 12 ml per month Tekturna HCT Procrit 3000U & 4000U 30 ml per month Teveten 400mg Prograf 0.5mg Teveten 600mg Prograf 1mg 8 capsules per day Teveten HCT Provigil 100mg ticlopidine Provigil 200mg tolazamide 250mg 4 tablets per day Pulmicort Flexhaler 2 inhalers per month tolazamide 500mg QVAR 40mcg/act 2 inhalers per month tolbutamide QVAR 80mcg/act 3 inhalers per month tramadol er 100mg Rapaflo Travatan Z 5 ml per month Rebif 12 syringes per month Twynsta Rebif Titration Pack 1 pack per month Uloric Regranex 2 tubes per month Ultram ER 100mg Relenza Diskhaler 62 blisters per month Uroxatral Relpax 6 tablets per month Valturna Riomet 25.5 ml per day venlafaxine 3 tablets per day Ritalin LA 10mg & 30mg venlafaxine er 150mg Ritalin LA 20mg 3 capsules per day venlafaxine er 37.5mg & 75mg 3 capsules per day Ritalin LA 40mg Vesicare Rozerem Viagra 5 tablets per month Samsca 15mg Vytorin Samsca 30mg Welchol Pack 1 packet per day Sanctura XR Xalatan 2 bottles 5 ml per month Sancuso 5 patches per prescription Xyrem 3 bottles per month Savella zaleplon 5mg 2 capsule per day Savella Titration Pack 1 pack per prescription zaleplon 10mg Serevent Diskus 2 blisters per day Zetia Simcor Zipsor 4 tablets per day Singulair zolpidem tartrate Singulair Chewable 1 chewable tablet per day Zomig Nasal Spray 6 devices per month Singulair Pack 1 packet per day Zyflo CR 4 tablets per day Spiriva Handihaler Zyprexa Sporanox Oral Solution 40 ml per day Zyprexa Zydis
Quantity limits on medications are established to maximize the dosing regimen and decrease cost.
Drug Quantity Limits 2011 Quantity limits on medications are established to maximize the dosing regimen and decrease cost. Quantity limits are commonly placed on once daily drugs available in multiple
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