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Quantity Limits

 

The medication listed below are subject to specific quantity limits. These quantity limits may be in addition to step therapy or prior authorization requirements. Quantity limits apply to both brand and generic versions of the medication unless otherwise specified. Exceptions to the quantity limits may be approved by the Pharmacy Help Desk when clinical circumstance warrant. Please call 1-800-522-0114, option 4.

PHARM-13 Statement of Medical Necessity for Quantity Limits Override

Last Modified on Dec 21, 2020
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