CurrentColorado Rocky Mountain Health PlansPolicy N/A

Copay Quantity Limits for Medications

Lists medications that have copay quantity limits (maximum quantity covered per copay or timeframe) and indicates whether overrides are permitted; applies to Colorado Rocky Mountain Health Plans' pharmacy benefits.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCopay Quantity Limits for Medications

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateN/A

Key ActionUse the listed per-drug quantity limits and override flags when determining copay supply limits for pharmacy dispenses.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multiple (hundreds)medications listed

180 MEDopioid dosing rule

Yes/Nooverride flags

6/1/2026effective date

Coverage criteria and quantity-limit rules

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Acanya - 1.2, 2.5%: Quantity Limit per copay = 50 grams per copay; Overrides = Yes.

Aczone - 5, 7.5%: Quantity Limit per copay = 60 grams per copay; Overrides = Yes.

Adrenaclick - 0.15, 0.3 mg: Quantity Limit per copay = 2 auto-injectors or 1 two pack per copay; Overrides = No.

Adzenys XR: Quantity Limit per copay = 31 tablets; Overrides = No.

Aemcolo: Quantity Limit per copay = 12 tablets; Overrides = No.

Afrezza: Quantity Limit per copay = 10 boxes; Overrides = Yes.

Airsupra: Quantity Limit per copay = 1 inhaler; Overrides = No.

Aklief: Quantity Limit per copay = 45 grams; Overrides = Yes.

Albuterol HFA: Quantity Limit per copay = 1 inhaler; Overrides = No.

Alinia - 100 mg: Quantity Limit per copay = 1 bottle; Overrides = Yes. Alinia - 500 mg: Quantity Limit per copay = 6 tablets; Overrides = Yes.

Basaglar: Quantity Limit per copay = 25 pens; Overrides = Yes.

Baqsimi: Quantity Limit per copay = 2 devices; Overrides = No.

Benzamycin gel - 3%/-5%: Quantity Limit per copay = 23.3 grams (1 jar) per copay; Overrides = Yes.

Bepreve - 1.5%: Quantity Limit per copay = 5 mL per copay; Overrides = No.

(This list continues in the same per-drug format throughout the document; each entry specifies the drug, the quantity limit per copay, and whether Overrides are permitted.)

Opioid dosing criteria

Special opioid dosing rule that applies to long-acting opioid products:

Opioids, long acting: Quantity Limit per copay = Opioid Cumulative Dose: 180 MED; Overrides = Yes.

Cumulative MED threshold applies to long-acting opioid therapy as specified in the list.

Opioids, short acting: Overrides = Yes.

No per-copay quantity value specified for short-acting opioids in this section; overrides are permitted.

Copay Quantity Limit Entries

Supply Limits / Copay quantity limit examples and override allowances. Inclusion on this list does not indicate coverage and drugs may be subject to additional program requirements.

Retin-A micro - 0.06, 0.08% gel: Quantity Limit per copay = 50 grams; Overrides = Yes.

Rextovy: Quantity Limit per copay = 1 package (2 devices); Overrides = No.

Reyvow - 50 mg: Quantity Limit per copay = 4 tablets; Overrides = No. Reyvow - 100 mg: Quantity Limit per copay = 8 tablets; Overrides = No.

Rezvoglar KwikPen: Quantity Limit per copay = 75 mL; Overrides = Yes.

Rhofade: Quantity Limit per copay = 30 grams; Overrides = No.

Sancuso: Quantity Limit per copay = 1 patch; Overrides = Yes.

Solosec: Quantity Limit per copay = 1 packet; Overrides = No.

Soolantra: Quantity Limit per copay = 45 grams; Overrides = No.

Symbravo: Quantity Limit per copay = 9 tablets; Overrides = No.

Synalar - 0.025% cream/ointment: Quantity Limit per copay = 120 grams; Overrides = No. Synalar topical solution: Quantity Limit per copay = 60 mL; Overrides = Yes.

Tuxarin ER: Quantity Limit per copay = 10 tablets; maximum 30 tablets per month (example of monthly maximum); Overrides = (document indicates per-drug override flags where specified).

Per-copay or monthly maximum examples cited in the source (e.g., Tuxarin ER max 30 tablets/month).

Medication lists and coding / numeric thresholds

Medication quantity limit entriesmixed

Multiple medications with specified quantity limits per copay and override flags; no billing codes provided in this section.

Listed drugs with specified quantity limits and override flagsmixed

No codes listed

Opioid cumulative dose threshold

Opioid cumulative dose threshold180 MED

Per-copay or monthly maximum examples

Tussionex exampleTussionex 120 mL; Overrides = No; (implied maximum example: 360 mL/month mentioned in brief)

Tuxarin ER exampleTuxarin ER 10 tablets per copay; maximum 30 tablets/month; Overrides = No

Zutripro exampleZutripro 120 mL; maximum 360 mL/month (example from brief)

What providers need to know and do

Note

Quantity limits and overrides summary — verify coverage and authorization

This document lists per-drug copay quantity/supply limits and whether overrides are permitted. Inclusion here does not guarantee that a drug is covered by a given plan; drugs may be subject to other requirements (e.g., Exclude at Launch, Review at Launch). Providers should verify plan-specific coverage and prior authorization requirements before prescribing.

Supply Limits = maximum quantity covered per copay or timeframe
Inclusion ≠ coverage — check plan benefits and prior authorization policies

Denial Risk

Opioid cumulative dosing rule

Opioid long-acting cumulative dosing limit applies: Quantity limit per copay expressed as Opioid Cumulative Dose = 180 MED (morphine equivalent dose). Overrides are permitted for opioids, long-acting (Overrides = Yes). For opioid short-acting, overrides are also permitted (Overrides = Yes). Providers must monitor cumulative MED and document rationale when requesting an override.

Opioids, long acting: Quantity Limit per copay = Opioid Cumulative Dose: 180 MED
Opioids, long acting: Overrides = Yes
Opioids, short acting: Overrides = Yes

Note

Supply Limits / Copay Quantity Limits — maximums per copay/timeframe

Supply limits set the maximum quantity covered per copay or timeframe (for example: Opzelura = 240 grams per copay; Oravig 50 mg = 14 tablets per copay; many other products listed with specific limits). Inclusion on the supply limits list does not guarantee coverage. Overrides vary by drug (Yes/No) — check the listed override status for the specific product when requesting an exception.

Examples: Opzelura — 240 grams per copay (Overrides = Yes); Oravig 50 mg — 14 tablets per copay (Overrides = No)
Inclusion on list = not a coverage guarantee; other utilization management may apply

Key definitions

Supply Limits definition

DefinitionSupply Limits establish the maximum quantity of drug that is covered per copay or in a specified timeframe.

PurposeUsed to set per-copay or timeframe quantity caps for medications listed in the formulary or policy.

ApplicabilityApplies to medications included in the copay quantity limit list; does not by itself determine coverage eligibility.

Inclusion statement

Inclusion noticeInclusion in this list does not indicate a drug is covered by a particular plan; drugs may be subject to additional requirements (e.g., Exclude at Launch, Review at Launch).

Effect on coverageListing is informational for quantity limits only; coverage determinations and additional program requirements may still apply.

Action for providersVerify patient-specific coverage and any program-specific requirements before prescribing or dispensing.

Supply Limits (alternate)

Alternate wordingSupply Limits: maximum quantity of drug that is covered per copay or in a specified timeframe (example: 30 grams per copay, 1 inhaler, 25 pens, or monthly maximums).

Example useUsed throughout the list to express per-copay limits and occasional monthly maximums (e.g., tablets/month or mL/month).

Relationship to overridesEach supply limit entry indicates whether an override/exception is permitted for that limit.

Overrides definition

Overrides flag meaningIndicates whether an exception or override is permitted for the listed quantity limit (Overrides = Yes or No).

When usedAppears alongside each medication’s quantity limit to show if prior authorization or exception processes can allow amounts beyond the stated limit.

Provider implicationIf Overrides = No, the listed limit is enforced without exceptions; if Yes, an approved override process may permit additional quantity.