CurrentUnitedHealthcarePolicy N/A

Supply Limits — Duration/Quantity Limits for Medications

Lists medications with duration or quantity supply limits and indicates maximum quantities covered in specified timeframes; applies to UnitedHealthcare pharmacy benefit administration and affects providers, pharmacists, and members subject to plan-specific coverage rules.

Policy Summary

PayerUnitedHealthcare

PolicySupply Limits — Duration/Quantity Limits for Medications

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionWhen prescribing or dispensing, verify the listed duration/quantity limit and Overrides flag for the specific product and follow plan-level rules before approving quantities beyond the stated supply limit.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multiplemedications listed with quantity limits

2/25/2026document last updated

3/1/2026effective date referenced

7-dayopioid short-acting example limit

Supply / Quantity Limit Criteria

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.

Supply limit criteria summary

This document enumerates per-product supply/quantity limits and indicates whether an 'Overrides' flag is set; inclusion on the list does not by itself establish plan coverage.

Per-product quantity or duration limits are specified (examples: '31 tablets per month', '1 inhaler', '4 pens/period').

Entries include an 'Overrides' indicator specifying whether the listed limit may be overridden (Yes/No).

Some products include special sequencing or annual/pack-level caps (e.g., starter packs, multi-month fill prerequisites, transmitter kits).

Inclusion in this list does not indicate a drug is covered by a particular plan; other program requirements (e.g., Exclude at Launch, Review at Launch) may apply.

Partial product supply limit entries

Partial extract — product entries shown with strength/form, a specified supply quantity and an Overrides flag (Yes/No).

Duaklir — 45 grams = 1 inhaler; Overrides = No.

Dupixent — 200, 300 mg = 2 prefilled syringes/pen injectors; Overrides = Yes.

Durlaza — 45 grams = 31 capsules; Overrides = No.

Estrogel — 1 metered pump (37.5 grams) = 1; Overrides = Yes.

Fentanyl transdermal patches — (37.5, 62.5 & 87.5 mcg/hr) = 10 patches; Overrides = Yes.

Freestyle Libre sensors/readers — examples include 2 sensors/21 days and 1 reader; Overrides = Yes.

Harvoni — treatment courses / 28 tablets (various strengths); Overrides = Yes.

Supply limit entries and special rules

Per-drug supply limits and special rules (selected entries and notable operational notes).

Kadian — 10, 20 & 30 mg = 62 capsules (Overrides = Yes); 50–80 mg = 31 capsules (Overrides = Yes); 100 mg requires Supply Limit Review.

Kalydeco — 5.8–75 mg = 56 tablets/packets; Overrides = No.

Kesimpta — single-use syringe/pen = 1 syringe or pen; Overrides = Yes.

Leqembi LQLIK — 360 mg = 4 autoinjectors per month; Overrides = No.

Mavenclad — 10 mg = 40 tablets per 720 days; Overrides = No.

Mavyret — (oral) = 168 tablets per 720 days; Overrides = Yes (oral pellets also listed).

Per-product supply limits (examples)

Example per-product limits (partial — Part 4 of 5).

Palynziq — 2.5 mg entry present; 10 mg = 14 syringes; Overrides = Yes for listed strengths.

Paxlovid — 1 course of therapy per copay and up to 2 courses per year (policy lists as 1 = 1 course/copay, 2 = 2 courses/year).

Ponvory — 20 mg = 30 tablets; Overrides = No for standard tablet entry; starter pack entries have separate annual limits.

Fill sequencing / special fill rules

Sequencing and special fill rules called out for specific products.

Mounjaro — two one‑month fills are required before a three‑month fill is available (when a three‑month fill is allowed).

Ozempic — certain presentations require two one‑month fills before allowing a 1‑pen quantity (see Ozempic entries).

Saxenda, Trulicity, Wegovy, Victoza and similar GLP‑1/weight‑loss products — require two one‑month fills before eligibility for a three‑month fill if allowed by plan rules.

Palforzia — level and starter packs use per‑13‑day pack limits and specified annual starter pack limits; sequencing built into pack definitions.

Supply limit rules and statements

Stated coverage stance and operational rules that apply across the Supply Limits section.

Supply Limits define the maximum quantity of a drug that is covered in a copay or specified timeframe; limits are expressed as counts per period (e.g., tablets/month, pens, packs/year).

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

Many entries include an 'Overrides' flag (Yes/No) indicating whether the listed quantity limit may be overridden through review or exception processes.

Operational constraint example: two one‑month fills are required before a three‑month fill is available for selected products (document lists several GLP‑1 and weight‑loss agents as examples).

Product Entries & Code-level Mapping

N/A - product-level quantity limitsmixed

No codes listed

product supply entries (partial)mixed

Duaklir	45 grams = 1 inhaler
Duavee	45 grams = 30 tablets
Duetact	30/2, 30/4 mg, 45 grams = 31 tablets
Duexis	800/26.6 mg, 45 grams = 93 tablets
Dulera	45 grams = 1 canister
Dupixent (100 mg)	45 grams = (unspecified)
Dupixent (200, 300 mg)	45 grams = 2 prefilled syringes/pen injectors
Durlaza	45 grams = 31 capsules
Duvyzat	45 grams = 420 mL
Duzallo	45 grams = 31 tablets

1–10 of 15

1/2

drug supply limit entriesmixed

Kadian (10,20,30 mg)	1 = 62 capsules
Kadian (50,60,80 mg)	1 = 31 capsules
Kadian (100 mg)	Requires Supply Limit Review
Kalydeco	5.8, 13.4, 25, 50 & 75 mg, 1 = 56 tablets/packets
Kesimpta	1 = 1 syringe or pen
Ketoprofen (25 mg)	1 = 124 capsules
Ketoprofen (50 mg)	1 = 186 capsules
Ketoprofen ER (200 mg)	1 = 31 capsules
Kisqali - 200 mg (daily dose blister)	1 = 21 tablets
Kisqali - 200 mg (600 mg daily dose blister)	1 = 63 tablets

Supply limit quantity entries (no formal code sets provided)mixed

Palynziq - 10 mg	1 = 14 syringes
Palynziq - 2.5 mg	2 = Yes
Paxlovid	1 = 1 course of therapy/copay; 2 courses of therapy/year
PEG-Intron	50, 80, 120 & 150 mcg, 1 = 4 redipens
Ponvory - Starter Pack	1 = 1 starter pack/year
Pradaxa pak - 150 mg	1 = 62 packets

drugs with duration quantity limits (by brand/formulation)mixed

Tremfya - Crohn Induction Pack - 200 mg	1 = 2 pens/1 box
Trikafta	1 = 84 tablets
Trikafta - packets	1 = 56 packets
Trulicity	1 = Two, one-month fills are required before a three-month fill is available (if allowed)
Triumeq	1 = 31 tablets
Trintellix - 20 mg	1 = 31 tablets

Quantity limits examples - monthly, per-device, periodic

Monthly limits (examples)31 tablets per month (common for many oral products, e.g., Abilify Discmelt, Aciphex, Conzip)

Per-device limits1 inhaler or 1 metered pump (examples: Duaklir = 1 inhaler; Estrogel = 1 metered pump)

Per-pen / prefilled syringe limitsLimits expressed as pens or syringes (e.g., 2 pens, 4 prefilled syringes per month for various biologics)

Periodic/yearly kit limitsTransmitter/kit limits expressed per year (e.g., Guardian Transmitter Kit = 1 transmitter kit/1 year)

Example supply limit format (entry conventions)

Entry format (product-level)Product - strength/form, 1 = quantity (units/timeframe); 2 = Yes/No (Overrides flag)

ExamplesEstrogel, 1 = 1 metered pump (37.5 grams). Estrogel, 2 = Yes.

Device exampleFentanyl Transdermal Patch - 37.5/62.5/87.5 mcg/hr, 1 = 10 patches. Fentanyl Transdermal Patch, 2 = Yes.

Mavenclad / Mavyret multi-year limits

Mavenclad multi‑year limitMavenclad - 10 mg: 1 = 40 tablets per 720 days

Mavyret multi‑year limitMavyret - 1 = 168 tablets per 720 days; oral pellets: 1 = 155 packets

ContextMulti‑year limits are expressed with a numerator (quantity) and an extended timeframe (e.g., per 720 days)

Annual / periodic supply thresholds - examples

Annual / 365‑day examplesEntries formatted as '24 tablets/year' or equivalent (examples: multiple products listed with '24 tablets/year' mapping to specific capsule/tablet totals)

Per‑year device/device pack examplesTremfya Crohn Induction Pack and other starter packs noted as per‑box or per‑year limits (e.g., starter pack = 1 pack/year)

Other periodic thresholdsExamples include '12 fills/year' or product‑specific annual capsule totals (e.g., 124 capsules/year entries)

Example supply limits — counts per time period

Counts per time period (tablets/pens)Examples: 31 tablets, 62 tablets, 4 pens (e.g., Wegovy = 4 pens; Xpovio packs = 4 tablets per pack)

Pack/kit countsStarter/induction packs expressed as pack counts (e.g., Tremfya Crohn Induction Pack = 2 pens/1 box)

Dose form varietyLimits include tablets, packets, pens, syringes, vials, bottles and doses per month as specified next to product names

Provider Notes, Overrides & Fill Rules

Note

Sequencing / fill rules noted

Some products in the Supply Limits list have sequencing or multi-fill prerequisites before longer fills are allowed (for example, two one-month fills are required before a three-month fill). Check the product-specific entry for any sequencing requirement prior to requesting extended fills.

Examples in the list: Bydureon Bcise; Byetta; Mounjaro; Ozempic; Saxenda; Saxenda/Semaglutide-class and other GLP-1 products where noted; Victoza; Wegovy; Wegovy/Wegovy pen packs; Victoza 2-pen and 3-pen pack distinctions.

Billing Rule

Fill sequencing / bundling note

Where sequencing or bundling is required, the policy enforces a fill-order prerequisite (e.g., two separate one-month fills must be dispensed before a three-month or larger pack is eligible). Verify the patient’s prior fills and dispense dates when submitting a PA or override request.

Specific examples in this Supply Limits list requiring two one-month fills before a longer fill: Mounjaro, Ozempic (4 mg/3 mL and certain pen sizes), Saxenda, Victoza (2‑pen pack before 3‑pen pack), Wegovy and other GLP‑1 products as indicated.

Denial Risk

Opioid supply restriction (opioid‑naïve)

Short-acting opioids dispensed to opioid‑naïve patients are limited to a 7‑day supply and cumulative opioid dose restrictions apply. Review dosing and cumulative morphine equivalent dose (MED) when approving fills.

Opioid-naïve short-acting opioid supply: 7-day supply.
Opioid cumulative dose threshold: less than 180 MED for the limited supply rule.

Note

Supply limits listing — provider note

Supply Limits establish the maximum quantity of a drug that is covered in a copay or within a specified timeframe. The list below shows per-product supply limits and any sequencing rules; inclusion on the list does not guarantee coverage under a particular plan.

Per-product supply limits and special prerequisites (pack-level limits, starter packs, year/pack limits) are listed in the Supply Limits table and product entries.
Inclusion does not indicate coverage — drugs may still be subject to other program requirements (e.g., Exclude at Launch, Review at Launch, prior authorization, step therapy, or quantity-limit overrides).

Documentation Required

Fill sequencing requirement (example)

Some products explicitly require multiple initial one-month fills before a longer-duration or larger pack is available; confirm that the required number of one-month fills has been dispensed and documented before authorizing a three-month or larger fill.

Operational example: Two one-month fills are required before a three-month fill is allowed for products such as Bydureon Bcise, Byetta, Saxenda, Victoza (pen pack sequencing), Wegovy, and similar GLP‑1 injectables where noted in the product entry.

Terminology & Key Definitions

Supply Limits — definition pointer

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

Scope noteThis list enumerates medications with duration quantity limits but does not by itself determine plan coverage; other program requirements may apply.

Effective/last review datesLast updated 2/25/2026; For 3/1/2026 Effective Date

Overrides — overrides flag definition

Definition — Overrides flag'Overrides' indicates whether the listed quantity limit may be overridden (entries show 'Overrides = Yes' or 'Overrides = No').

Usage in entriesMany product rows include an Overrides value immediately after the quantity entry (e.g., Abilify Discmelt, Overrides = Yes).

Operational impactOverrides control whether an exception to the posted supply limit is permitted during benefit adjudication.

Supply Limits — alternate pointer

Repeat definition — Supply LimitsSupply Limits establish the maximum quantity of drug that is covered in a copay or a specified timeframe.

List purposeThe document is a comprehensive list of medications that have a duration quantity limit and is referenced throughout the file.

Coverage caveatInclusion in this list does not indicate a drug is covered by a particular plan; additional reviews or exclusions may apply.

Inclusion caveat — being listed does not indicate plan coverage

Inclusion caveatInclusion 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.

Repeated noticeThe coverage caveat appears multiple times in the document (header and section repeats) to emphasize non‑coverage implication.

Provider implicationProviders should not assume plan coverage solely because a product and limit are listed; verify plan‑level benefit rules.

Supply Limits — duplicate definition reference

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

Document roleThis document enumerates per‑product duration/quantity limits and an Overrides indicator but does not itself establish plan coverage.

Cross referencesSome entries include additional program flags (e.g., Requires Supply Limit Review, starter pack/year) affecting coverage and dispensing.

Coverage caveat — inclusion doesn't indicate coverage; other requirements may apply

Coverage caveat (duplicate)Inclusion in this list does not indicate a drug is covered by a particular plan; other requirements (Exclude at Launch, Review at Launch) may apply.

Action for reviewersConfirm plan‑specific coverage and any additional utilization management requirements before authorizing beyond the listed limit.

VisibilityThis caveat is presented repeatedly across the document to ensure awareness.

Supply Limits — duplicate definition reference

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

PurposeThe list is used operationally to limit quantities at point of adjudication and to document per‑product caps.

Documentation noteEntries often include both a numeric quantity and an Overrides flag to indicate exception handling.

Duration quantity limit — explicit definition

Duration quantity limit — definitionDuration quantity limit = the maximum quantity of drug that is covered in a copay or specified timeframe.

Example wordingThe header states: 'Supply Limits establish the maximum quantity of drug that is covered in a copay or a specified timeframe.'

Operational effectThis definition drives adjudication limits (e.g., enforce 31 tablets/month or 4 pens per period).

Supply Limits — duplicate definition reference

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

UsageUsed throughout the document as the core concept for listed product entries and caps.

Exception handlingOverrides flags and 'Requires Supply Limit Review' notes indicate where exceptions or additional review are possible.

Duration quantity limit — duplicate definition reference

Duration quantity limit (duplicate)Duration quantity limit equals the maximum quantity of drug covered in a copay or specified timeframe (same wording repeated in document headers).

ImplicationLimits are enforced at claim adjudication and may be subject to override or additional review per entry flags.

Example entriesDocument shows many product entries with explicit '1 = X units' and '2 = Yes/No' flags tied to this definition.