Responsible Quantity Program — Drug Dispensing Quantity Limits
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Defines monthly (or other interval) dispensing quantity limits for numerous prescription drugs under Florida Blue's Responsible Quantity Program; applies to providers and pharmacies submitting claims and to generic versions where applicable.
No material clinical or coverage changes in this revision.
Drug Dispensing Quantity Limits
sample_drug_limits_from_document
Per-drug dispensing limits (examples extracted from the list):
Dispensing limit entries
Drug-specific default strengths and dispensing limits are listed; unless otherwise noted, the listed per-month (or per-period) quantities apply.
Per-drug dispensing limits
For each listed drug, the policy specifies a default strength/form (if none listed assume the indicated default) and a Dispensing Limit Per Month (or per specified days). Limits apply unless otherwise noted; exceptions may be handled via the Quantity Limit Authorization Form.
Sample dispensing limits
Drug-specific dispensing limits (examples shown) — unless otherwise noted, limits apply per month or per the specified period.
Per-drug quantity limit entries
Per-drug dispensing limits (examples shown; document contains many additional entries across chunks 72–91).
Dispensing quantity limits (selected entries)
Per-drug dispensing limits (examples from excerpt):
Per-product dispensing limits (excerpt)
Per-product dispensing limits are specified; where noted, limits apply per month or per specified period.
Dispensing quantity criteria (excerpt)
Per-product dispensing quantity limits listed; some limits are per month, per 28 days, per 56 days, per 84 days, per 365 days, per lifetime, or other specified period.
Per-drug dispensing limits (excerpt)
Per-drug dispensing limits (default monthly or specified period) listed; each entry gives drug name, strength (where listed) and Dispensing Limit Per Month unless otherwise noted.
Note
- This segment (W–Z) contains many additional drug-specific limits across strengths and specified periods; refer to the full list for product- and strength-specific dispensing limits.
Coding / Examples of Limits
| Per-drug dispensing limits (e.g., abacavir = 60 tabs/month; Abilify (aripiprazole) = 30 tabs/month; Abilify Discmelt (aripiprazole ODT) = 60 tabs/month; Actemra = 4 syringes or autoinjectors/28 days) |
| Example entries: Brixadi = 4 syringes/28 days; Brukinsa = 120 caps/month or 60 tabs/month; Buphenyl (sodium phenylbutyrate) = 1200 tabs/month |
| Per-product dispensing limit entries (drug name, strength/form, dispensing limit per month or specified period) |
| Per-drug dispensing limits (examples: Kynamro = 4 vials/28 days; Kyzatrex = 60 caps/month (100 mg) or 120 caps/month (150/200 mg); Lagevrio (molnupiravir) = 40 caps/month; lamivudine 100 mg = 30 tabs/month) |
| Per-drug dispensing limits (examples: Ponvory = 30 tabs/month; Pradaxa = 120 caps or 60 caps depending on strength; Pretomanid = 182 tabs/365 days; Prevnar 20 = 1 vaccine/90 days) |
| Multiple drugs with strength and dispensing limit examples (e.g., Scemblix = 120 tabs/month; Seebri Neohaler = 60 caps/month; Selzentry = 60 or 120 tabs/month or 1840 mL; Shingrix = 2 vaccines/lifetime) |
| 50 mg/5 mL (vancomycin) | Strength listed for vancomycin oral liquid |
| 125 mg, 250 mg (Vancocin) | Capsule strengths listed for Vancocin (vancomycin) |
| This document lists drugs in the W–Z range and their dispensing limits (examples: Wezlana = 1 syringe/56 days; Xalatan = 2.5 mL; Xalkori = 60–180 caps depending on formulation; Xarelto = 30/60/51 tabs depending on strength or starter pack) |
Authorization and Override Process
Use Quantity Limit Authorization Form for exceptions
Quantity Limit Authorization Form is referenced for requesting exceptions to listed quantity limits.
Quantity Limit Authorization Form available online
The Quantity Limit Authorization Form is available at the provided URL; Responsible Quantity program limits apply to generic versions of drugs where applicable.
- Form URL: http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_QuantityLimit.pdf
- Program limits apply to generic versions where applicable.
Responsible Quantity limits apply to generics; use form for exceptions
Responsible Quantity program limits apply to generic versions of drugs where applicable; refer to the Quantity Limit Authorization Form for exceptions or overrides.
- Limits are not limited to brand products and apply to generics where available.
- Use the Quantity Limit Authorization Form to request exceptions.
Reference Quantity Limit Authorization Form for requests
The Quantity Limit Authorization Form is referenced as the mechanism to request quantity limit approvals or overrides.
Submit requests via Quantity Limit Authorization Form
Providers must use the Quantity Limit Authorization Form when requesting authorization for quantities beyond the listed limits.
Quantity limit exception requests require the Form
The policy repeatedly references the Quantity Limit Authorization Form as the process for requesting exceptions to responsible quantity limits.
Use the Authorization Form to request overrides
For any request to exceed the Responsible Quantity Program limits, submit the Quantity Limit Authorization Form as specified in the policy.
External Quantity Limit Authorization Form for overrides
The Quantity Limit Authorization Form is provided via external URL for requesting overrides or authorizations to quantity limits.
- Form URL provided in document for submission of requests.
Quantity Limit Authorization Form available at URL
The Quantity Limit Authorization Form is available at the document’s provided URL for submitting quantity-limit authorization requests.
- Refer to the linked form at http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_QuantityLimit.pdf
Reference the Authorization Form for exceedance requests
The Quantity Limit Authorization Form is referenced for authorization requests to exceed listed dispensing limits.
Quantity Limit Authorization Form (link)
Quantity Limit Authorization Form is available at http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_QuantityLimit.pdf for submitting requests to exceed quantity limits.
Form referenced; generics are subject to limits
The Quantity Limit Authorization Form is referenced on policy pages (link provided); Responsible Quantity program limits apply to generic versions of drugs where applicable.
- Form link included in policy pages.
- Program limits apply to generics where available.
Repeat: submit form for exceptions (generics apply)
The Quantity Limit Authorization Form is reiterated on current-dated pages; use it to request exceptions to the Responsible Quantity Program limits that may apply to generic versions.
Submit Quantity Limit Authorization Form for exceptions
The Quantity Limit Authorization Form is available at the provided URL for requesting exceptions or authorizations to quantity limits under the Responsible Quantity Program.
- Form URL: http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_QuantityLimit.pdf
- Used to request exceptions/authorizations to quantity limits.
Key Terms and Scope
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