CurrentUnitedHealthcarePolicy N/A

Copay Quantity Limits (Supply Limits) for Medications

Lists medications that have a copay quantity limit (maximum quantity covered per copay or timeframe) and notes that inclusion does not guarantee coverage; applies to UnitedHealthcare plan administration of copay supply limits.

Policy Summary

PayerUnitedHealthcare

PolicyCopay Quantity Limits (Supply Limits) for Medications

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionApply the listed per-copay quantity limits and check the Overrides flag for each medication when administering plan copay supply limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

per-copay limitsprimary policy feature (quantity limits)

Yes/NoOverrides flag present

20+document chunks in this partial extract

multiple hundredlisted medications (partial)

2026-02-25last updated

Copay Quantity Limit Criteria

Supply Limit Criteria

Per-copay quantity limits and an Overrides indicator for each listed medication.

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

Medication entries (examples)

Acanya - Quantity Limit per copay = 50 grams. Overrides = Yes.
Aczone - Quantity Limit per copay = 60 grams. Overrides = Yes.
Adrenaclick - Quantity Limit per copay = 2 auto-injectors or 1 two pack per copay.

Policy Summary

PayerUnitedHealthcare

PolicyCopay Quantity Limits (Supply Limits) for Medications

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionApply the listed per-copay quantity limits and check the Overrides flag for each medication when administering plan copay supply limits.

SourceLink

On This Page

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.

Coverage Notes and Quantity Limit Rules

Stated coverage stance and limitations

Inclusion in this list does not indicate a drug is covered by a particular plan.

Any drug may be subject to other requirements including but not limited to Exclude at Launch and/or Review at Launch.

Each listed medication includes a 'Quantity Limit per copay' and an 'Overrides' flag indicating whether overrides are allowed.

Examples of specific quantity limits from list

Ventolin HFA = 1 inhaler per copay (example format from list).
Taclonex = 60 grams per copay (example format from list).
Tussionex example maximum = 360 mL/month (sample threshold referenced in brief).

Listing medications and quantity limits here are supply limits only; listing does not guarantee plan coverage.

Codes, Dose Limits, and Examples

No billing or clinical codes provided in this extractmixed

No codes listed

Medications (no codes)mixed

No standardized CPT/HCPCS/ICD codes provided in this section; entries are medication name plus quantity limits and override flags.

Opioid cumulative dose limit

Opioid cumulative dose limitOpioid Cumulative Dose: 180 MED

Opioids, long acting - OverridesYes

Opioids, short acting - OverridesYes

Context / effective dateLast updated 2/25/2026 (For 3/1/2026 Effective Date)

Examples of per-month or per-copay maximums

Tussionex per-copay limitQuantity Limit per copay = 120 mL; maximum 360 mL/month

Tuxarin ER per-copay limitQuantity Limit per copay = 10 tablets; maximum 30 tablets/month

Tussionex OverridesNo

Tuxarin ER OverridesNo

Operational Notes and Override Indicators

Billing Rule

Copay Quantity Limits with Override Flags

The following is a comprehensive list of medications that have a copay quantity limit. Supply Limits establish the maximum quantity of drug that is covered per copay or in a specified timeframe. Inclusion in this list does not indicate a drug is covered by a particular plan. Any drug may be subject to other requirements including but not limited to Exclude at Launch and/or Review at Launch.

Acanya (1.2%, 2.5%) — Quantity Limit per copay: 50 grams. Overrides: Yes.
Aczone (5%, 7.5%) — Quantity Limit per copay: 60 grams. Overrides: Yes.
Adrenaclick (0.15 mg, 0.3 mg) — Quantity Limit per copay: 2 auto-injectors or 1 two-pack (per mL) per copay. Overrides: (see plan)
Bepreve (1.5%) — 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.
Rhopressa — Quantity Limit per copay: 2.5 mL. Overrides: No.
RiVive — Quantity Limit per copay: 2 devices. Overrides: No.
Rocklatan — Quantity Limit per copay: 2.5 mL. Overrides: No.
Ryaltris — Quantity Limit per copay: 1 bottle (29 g) per copay. Overrides: No.
Sancuso — Quantity Limit per copay: 1 patch. Overrides: Yes.
Santyl — Quantity Limit per copay: 90 grams. Overrides: Yes.
Sernivo — Quantity Limit per copay: 120 mL. Overrides: Yes.
Simbrinza — Quantity Limit per copay: 1 bottle (8 mL). Overrides: No.
Sitavig — Quantity Limit per copay: 1 tablet. Overrides: No.
Sivextro — Quantity Limit per copay: 6 tablets. Overrides: No.
Solaraze — Quantity Limit per copay: 100 grams. Overrides: Yes.
Solosec — Quantity Limit per copay: 1 packet. Overrides: No.
Soolantra — Quantity Limit per copay: 45 grams. Overrides: No.
Sorilux Foam (0.005%) — Quantity Limit per copay: 60 grams. Overrides: Yes.
Sprix — Quantity Limit per copay: 5 bottles. Overrides: Yes.
Sprycel (20 mg) — Quantity Limit per copay: 62 tablets. Overrides: Yes.
Sprycel (50 mg, 70 mg) — (quantity/override information continues in full policy)

Key Terms

Supply Limits — definition

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

PurposeIndicates the listed maximum quantity that will be considered for a single copay or within a defined timeframe (e.g., per month).

Coverage noteInclusion in this list does not indicate a drug is covered by a particular plan; drugs may be subject to other requirements such as Exclude at Launch or Review at Launch.

Overrides — definition

DefinitionOverrides flag: an entry indicating whether overrides are permitted for the listed quantity limit (Yes/No).

Operational useSpecifies if an exception or override can be requested/approved for the quantity limit associated with the drug.

DisplayEach medication entry includes a separate 'Overrides' field (e.g., Overrides = Yes or Overrides = No).

Supply Limits — alternate phrasing

Alternate phrasingSupply Limits: maximum quantity of a drug covered per copay or within a specified timeframe (e.g., per copay, per month).

Example usageEntries list the medication, quantity limit per copay, and any timeframe cap (e.g., 120 mL per copay; maximum 360 mL/month).

ImplicationListing indicates the administered plan's per-copay limit but does not guarantee plan coverage for the drug.

Overrides — alternate phrasing

Alternate phrasingOverrides: indicates whether an override (Yes/No) is permitted for the listed quantity limit.

Binary fieldRecorded as 'Overrides = Yes' or 'Overrides = No' alongside each medication entry.

Policy noteAn 'Overrides = Yes' entry indicates exceptions may be allowed; 'Overrides = No' indicates no override is permitted for that quantity limit.