Drugs Subject to Quantity Limits
Some prescription drugs may be subject to quantity limits, based on criteria developed by the State Health Plan or its representative. Prior approval is required before excess quantities of certain drugs will be covered. If you need quantities in excess of the limit for a drug that is subject to quantity limits, it is important to make sure your provider has received prior authorization before you go to the pharmacy.
If the drug you are looking for is not listed in the chart below, please check Drugs Requiring Prior Approval and Drugs Requiring Step Therapy.
Pharmacy Policy Update Notifications - Please note the draft policies are highlighted below with effective dates. Any provider comments on the policies should be sent 30 days prior to the effective date. Send them to pharmacycomments@shpnc.org.
**TO INITIATE A COVERAGE REVIEW, providers should visit www.medco.com/coverage or call 800-753-2851**
