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 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 quantity limits, the generic will have the same quantity limit. Abilify oral solution Abilify Abilify Discmelt Acarbose 100mg Acarbose 25mg Acarbose 50mg Accolate Actonel 150mg Actonel 5mg & 30mg Actonel 35mg Actoplus Met Actos Adcirca Adderall XR 5mg, 10mg & 15mg Adderall XR 20mg, 25mg & 30mg Advair Diskus Advair HFA 25 ml per 6 tablets per 1 tablet per 4 tablets per 2 blisters per 1 inhaler per Advicor 1,000mg- 20mg,500mg-20mg, 750mg-20mg Advicor 1,000mg- 40mg Aerobid-M Aggrenox Allegra Allegra-D (12-Hour) Allegra-D (24-Hour) Altoprev Alvesco Ambien CR Amerge Amitiza Amphetamine/ Anzemet 100mg Tablet Anzemet 50mg Tablet 3 inhalers per 10 ml per 2 inhalers per 9 tablets per 3 tablets or a 3 supply 6 tablets or a 3 supply 1
Apriso Aranesp syringes Aranesp vials Aranesp 500mcg/ml Injection Arixtra Asmanex Astelin Astepro Atacand 16mg Atacand 4mg & 32mg Atacand 8mg Atacand HCT 16-12.5mg Atacand HCT 32-12.5mg & 32-25mg Avalide 150-12.5mg Avalide 300-12.5mg. & 200-25mg Avandamet Avandaryl Avandia 2mg Avandia 4mg Avandia 8mg Avapro 150mg Avapro 300mg Avapro 75mg Avodart Avonex 4 tablets per 4 syringes per 4 vials per 1 syringe per 3 weeks 1 syringe per 1 inhaler per 1 kit per Axert Azelastine HCl (Nasal Spray) Azor Beconase AQ Benicar 20mg Benicar 5mg & 40mg Benicar HCT Betaseron Boniva (Injection) Boniva (Tablet) Budeprion SR 100mg 12-Hour Budeprion SR 150mg 12-Hour Budeprion XL 150mg 24-Hour Budeprion XL 300mg 24-Hour Buprenorphine 2mg Buprenorphine 8mg Buproban Bupropion 100mg Bupropion 75mg Tablet Bupropion SR 100mg 12-Hour Bupropion SR 150mg & 200mg 12-Hour Butorphanol 14 vials per 1 syringe per 3 s 1 tablet per 4 tablets per 16 tablets per 8 tablets per 4 tablets per 4 tablets per 2
Byetta Bystolic 2.5mg Bystolic 5mg Bystolic 10mg Bystolic 20mg Caduet Calcitonin Nasal Spray Cardene SR Cardura XL Celebrex 100mg Celebrex 50mg, 200mg & 400mg Cetirizine Chantix 0.5mg & 1mg Chantix Pak Chlorpropamide 100mg Chlorpropamide 250 mg Clarinex (Syrup) Clarinex (Tablet) & Reditabs Clarinex-D (12-Hour Tablet) Clarinex-D (24-Hour Tablet) Clonidine patch 0.1mg Clonidine patch 0.2mg & 0.3mg Colcrys Concerta 18mg, 27mg & 54mg CR 1 pen per 4 tablets per 3 capsules per 10 ml per 53 tablets per 7 tablets per 10 ml per of 1 patch per 7 s 2 patches per 7 s 4 tablets per Concerta 36mg CR Copaxone Covera-HS 180mg Covera-HS 240mg Crestor Daytrana Detrol Detrol LA Dexilant Dexmethylphenidate HCl 10mg 5mg ER 10mg ER 15mg ER 5mg Dihydroergotamine Dilaudid Diltiazem ER 180mg Diltiazem ER 240mg Diltiazem ER 300mg, 360mg & 420mg Diovan 40mg, 80mg & 160mg Diovan 320mg Diovan HCT 160-12.5mg, 160-25mg, & 80-12.5mg 1 kit per 1 patch per 6 tablets per 5 capsules per 4 capsules per 24 ampules per 160 ml per 3
Diovan HCT 320-12.5mg, & 320-25mg Divigel Dorzolamide Dorzolamide/Timolol Dronabinol 10mg Dronabinol 2.5mg & 5mg Duetact Dynacirc CR 10mg Dynacirc CR 5mg Effient Eligard 22.5mg Eligard 30mg Eligard 45mg Eligard 7.5mg Emend 80mg & 125mg Emend 40mg Emend Tripak Emsam Enablex Enbrel 25mg Enbrel 25mg/0.5ml & 50mg/ml Ergomar 2 packets per 1 bottle (10 ml) per 1 bottle (10 ml) per 6 capsules per 1 kit per 3 s 1 kit per 4 s 1 kit per 6 s 1 kit per 6 capsules per 1 patch per 4 syringes per 8 syringes per 20 tablets per Ergotamine Tartrate/Caffeine Estring Estrogel Evista Exforge 10-160mg, 10-320mg, 5-320mg Exforge 5-160mg Exforge HCT Fanapt Fanapt Titration Pack Femring Fentanyl patch 75mch & 100mcg Fentanyl Patch 12mcg, 25mcg,& 50mcg Fentanyl Oral lozenge Firmagon 120mg Firmagon 80mg Flovent HFA Fluoxetine DR Cap (90mg) Focalin XR 5mg, 10mg,& 15mg Focalin XR 20mg Foradil Aerolizer Fortamet 1000mg Fortamet 500mg 40 tablets per 1 ring per 3 s 1 packet per 1 ring per 3 s 31 patches per 15 patches per 4 lozenges per 2 vials per 1 vial per 2 inhalers per 4 capsules per 5 tablets per 4
Fortical Fosamax (Oral Solution) Fosamax Plus D Fragmin 7500U & 10000U Fragmin 2,500U & 5000U Fragmin 25,000U Frova Gavilyte-G Gavilyte-N/Flavor Pack Gelnique Genotropin Miniquick Glimepiride 1mg Glimepiride 2mg Glimepiride 4mg Glipizide 10mg Glipizide 5mg Glipizide ER 10mg Glipizide ER 2.5mg Glipizide ER 5mg Glipizide/Metformin 2.5-250mg Glipizide/Metformin 2.5-500mg & 5-500mg Glumetza Glyburide 1.25mg Glyburide 2.5mg 5 bottles per 4 tablets per 1 syringe per 2 syringes per 1 vial per 18 tablets per one per one per 1 pack per 1 cartridge per 8 tablets per 4 tablets per 4 tablets per 8 tablets per 8 tablets per 4 tablets per 8 tablets per 4 tablets per 4 tablets per 16 tablets per 8 tablets per Glyburide 5mg Glyburide Micronized 1.5mg Glyburide Micronized 3mg Glyburide Micronized 6mg Glyburide/Metformin 1.25-250mg Glyburide/Metformin 2.5-500mg & 5-500mg Glycron 1.5mg Glycron 3mg Glycron 6mg Glyset Granisetron HCl Granisol Halflytely Bowel Prep Helidac Humira Pen Humira 20mg Humira 40mg Hydromorphone HCl Imitrex Intron-A Invega Sustenna Itraconazole Janumet Januvia 4 tablets per 8 tablets per 4 tablets per 8 tablets per 4 tablets per 8 tablets per 4 tablets per 6 tablets or a 3 s supply 30 ml or a 3 s supply one per 1 kit per 6 s 1 kit per 1 kit per 2 kits per 6 devices per 4 syringes per 1 syringe per 130 capsules per 5
Kadian 100mg & 200mg Kadian 10mg,20mg,30mg, 50mg, 60mg, & 80mg Kaletra 100-25mg Kaletra 200-50mg Kaletra Oral Solution Ketorolac 15mg inj Ketorolac 30mg onj Ketorolac Tablet Kineret Lansoprazole Lescol 20mg Lescol 40mg Lescol XL Levorphanol Lidoderm Lipitor Losartan 100mg Losartan 25mg, & 50mg Losartan/HCT 100-12.5mg & 100-25mg Losartan/HCT 50-12.5mg Lotrel Lotronex 6 capsules per 4 capsules per 4 tablets per 13 ml per 40 ml per 20 ml per 4 tablets per up to 5 s 1 syringe per 16 tablets per 3 patches per Lovenox Lovenox 300mg/3ml only Lumigan Lunesta Lupron Depot 11.25mg & 22.5mg Lupron Depot 3.75mg & 7.5mg Lupron Depot 30mg Maxalt Maxalt-MLT Meperidine Oral Solution Meperidine Metadate CD 10mg, & 30mg Metadate CD 20mg Metadate CD 40mg, 50mg, & 60mg Metformin 1000mg Metformin 500mg Metformin 850mg Metformin ER 500mg Metformin ER 750mg Methadone Concentrate Methadone Oral Solution Methadone Methadose 2 syringes per 1 vial per 2 bottles (5 ml) per 1 kit per 3 s 1 kit per 1 kit per 4 s 240 ml per 16 tablets per 3 capsules per 5 tablets per 4 tablets per 24 ml per 60 ml per 6 tablets per 6 tablets per 6
Methylin 10mg Chewable Methylin 10mg/5ml Oral Solution Methylin 2.5mg & 5mg Chewable Methylin 5mg/5ml Oral Solution Methylin Methylin ER Methylphenidate Methylphenidate SR Miacalcin Micardis Micardis HCT Migergot Migranal Morphine Sulfate Morphine Sulfate ER 100mg & 200mg Morphine Sulfate ER 15mg, 30mg, 60mg Naratriptan Nasacort AQ Nasonex Nateglinide Nexium Nexium (Pack) Nicotrol Inhaler 6 tablets per 30 ml per 60 ml per 20 suppositories per 1 kit per 6 tablets per 4 tablets per 9 tablets per 2 packets per 18 inhalers per 6 s Nicotrol NS Nisoldipine ER 8.5mg, 17mg, 25.5mg, & 34mg Nulytely/Flavor Packs Octreotide 100mcg/ml, 200mcg/ml, & 50mcg/ml Octreotide Acetate 500mcg/ml Omeprazole Ondansetron 24mg Ondansetron 4mg & 8mg Ondansetron HCl (Oral Solution) Ondansetron ODT Onglyza Opana ER Orencia Oxandrolone 10mg Oxandrolone 2.5mg Oxycodone HCl Oxycontin (10mg 12- Hour Tablet, 15mg 12-Hour Tablet, 20mg 12-Hour Tablet, 30mg 12- Hour Tablet, 40mg 12-Hour Tablet, 60mg 12-Hour Tablet) 720 ml per 6 s 4 ml per 3 ml per 3 tablets or a 3 s supply 9 tablets or a 3 s supply 100 ml or a 3 s supply 9 tablets or a 3 s supply 4 tablets per 4 vials per 4 tablets per 16 tablets per 4 tablets per 7
Oxycontin (80mg 12- Hour Tablet) Oxytrol Pantoprazole Paroxetine HCl ER 12.5mg Paroxetine HCl ER 25mg Paroxetine HCl ER 37.5mg Patanase Plavix 300mg Plavix 75mg Prandin 0.5mg, & 1mg Prandin 2mg Prevpac Prezista Pristiq Procrit 10,000U & 20,000U Procrit 2,000U Procrit 3000U & 4000U Prograf 0.5mg Prograf 1mg Provigil 100mg Provigil 200mg Pulmicort Flexhaler 6 tablets per 2 patches per 7 s 6 tablets per 3 tablets per 4 tablets per 8 tablets per 14 daily administration packs per 6 s 12 ml per 15 ml per 30 ml per 8 capsules per 2 inhalers per QVAR 40mcg/act QVAR 80mcg/act Rapaflo Rebif Rebif Titration Pack Regranex Relenza Diskhaler Relpax Riomet Ritalin LA 10mg & 30mg Ritalin LA 20mg Ritalin LA 40mg Rozerem Samsca 15mg Tablet Samsca 30mg Tablet Sanctura XR Sancuso Savella Savella Titration Pack Serevent Diskus Simcor Singulair Chewable 2 inhalers per 3 inhalers per 12 syringes per 1 pack per 2 tubes per 62 blisters per 6 tablets per 25.5 ml per 3 capsules per 5 patches per 1 pack per 2 blisters per 1 chewable tablet per 8
Singulair (Pack) Singulair (Tablet) Spiriva Handihaler Sporanox (Oral Solution) Strattera 60mg. 80mg & 100mg Strattera 10mg, 18mg, 25mg, & 40mg Suboxone Sumatriptan Injection Sumatriptan Symbicort Symlin (1000mcg/ml Injection) Symlin (600mcg/ml Injection) Tacrolimus 0.5mg Tacrolimus 1mg Tamiflu 30mg Tamiflu 45mg & 75mg Tamiflu (Oral Suspension) Tamsulosin Tekturna Tekturna HCT Teveten (400mg Tablet) 1 packet per 40 ml per 8 doses per 9 tablets per 1 inhaler per 4 pens per 4 vials per 8 capsules per 6 31 capsules per 6 bottles Teveten (600mg Tablet) Teveten HCT Ticlopidine HCl Tolazamide 250mg Tolazamide 500mg Tolbutamide Tramadol ER (100mg 24-Hour Tablet) Travatan Z Twynsta Uloric Ultram ER (100mg 24-Hour Tablet) Uroxatral Valturna Venlafaxine Venlafaxine ER 150mg Venlafaxine ER 37.5mg & 75mg Vesicare Vytorin Welchol (Pack) Xalatan Xyrem Zaleplon 10mg Zaleplon 5mg Zetia Zipsor Zolpidem Tartrate 4 tablets per 6 tablets per 5 ml per 3 capsules per 1 packet per 2 bottles (5 ml) per 3 bottles per 4 tablets per 9
Zomig (Nasal Spray) Zomig & ZMT Zyflo CR Zyprexa Zyprexa Zydis 6 devices per 9 tablets per 4 tablets per 10