CurrentUnitedHealthcarePolicy N/A

Medication supply quantity limits (duration quantity limits)

This document lists medications with duration-based supply limits (maximum quantities covered per copay or timeframe) and notes override status; it applies to UnitedHealthcare plan coverage determinations where listed. Inclusion does not guarantee coverage and drugs may be subject to other requirements.

Policy Summary

PayerUnitedHealthcare

PolicyMedication supply quantity limits (duration quantity limits)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateFor 5/1/2026 Effective Date

Next Review DateN/A

Key ActionCheck the listed medication entries for per-product quantity limits and override (Yes/No) flags when determining plan coverage eligibility.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5/1/2026effective date referenced

4/22/2026last updated

31 tablets / 2 syringes / 1 inhalertypical supply limits

20+entries in excerpt

multipleoverride flags present

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.

Medication Supply Limit Entries

inv-01: Supply limit entries

For each listed product the table provides: product name, strength/formulation, quantity limit per timeframe, and Overrides (Yes/No).

Abilify Discmelt - 10, 15 mg tablets; Quantity Limit per month = 31 tablets; Overrides = Yes

Abilify MyCite Starter Kit - 2, 5, 10, 15, 20 & 30 mg; Quantity Limit per month = 30 tablets; Overrides = Yes

Abilify MyCite Maintenance Kit - 2, 5, 10, 15, 20 & 30 mg; Quantity Limit per month = 30 tablets; Overrides = No

Abrilada; Quantity Limit per month = 2 prefilled syringes/autoinjectors; Overrides = Yes

Aciphex - 20 mg; Quantity Limit per month = 31 tablets; Overrides = Yes

Actemra ACTpen (subcutaneous) - 162 mg; Quantity Limit per month = 4 prefilled syringes/autoinjectors; Overrides = No

Acthar Gel / Purified Cortrophin Gel; Quantity Limit per month = 4 vials; Overrides = Yes

Acthar Gel SelfJect; Quantity Limit per month = 21 injectors; Overrides = No

Actimmune; Quantity Limit per month = 17 vials; Overrides = Yes

inv-02: Supply limit coverage guidance

Stated policy stance regarding the list

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

Many medication entries include a Yes/No flag indicating whether an override/authorization may be permitted for the listed quantity limit; plan-level applicability varies.

inv-03: Supply limit criteria (informational)

This excerpt provides per-product duration/quantity limits and notes about coverage applicability.

Each medication entry maps strength/formulation to a maximum quantity and timeframe (e.g., tablet counts, syringes, vials, inhalers) or provides a reviewer action such as 'Requires Supply Limit Review'.

Inclusion does not guarantee coverage; products listed may be subject to additional utilization management (e.g., Exclude at Launch, Review at Launch).

Examples of informational entries

Kuvan - 100 mg; 31 tablets = 496 tablets; Overrides = Yes
Latuda - 20, 40, 60 & 120 mg; 31 tablets = 31 tablets; Overrides = No
Mavyret; 1 = 168 tablets per 720 days; Overrides = Yes

inv-04: Example supply-limit criteria

Selected examples from the duration quantity limit list (partial):

Repatha - 140 mg; 1 = 2 syringes/pens; Overrides = Yes

Rybelsus (all strengths) - two one-month fills required before a three-month fill is available (if allowed).

Tremfya - 100 mg; 60 sublingual tablets = 1 device/1 syringe every two months; Overrides = Yes

Trikafta - 60 sublingual tablets = 84 tablets; Overrides = No

inv-05: Duration quantity / supply limits

List of medications with duration quantity limits; inclusion does not guarantee coverage and additional plan requirements may apply.

Tracleer - 62.5, 125 mg; 60 sublingual tablets = 62 tablets; Overrides = No

Trikafta - 60 sublingual tablets = 84 tablets; Overrides = No

Veltassa - 1 gm; 60 sublingual tablets = 124 packets; Overrides = Yes

Venclexta - 10 mg; 60 sublingual tablets = 14 tablets; Overrides = Yes

Verkazia - 0.1%; 60 sublingual tablets = 120 vials; Overrides = (entry incomplete in excerpt)

Quantity and Supply Mappings / Examples

Quantity limit examplesmixed

Abilify Discmelt	10, 15 mg = 31 tablets/month (Overrides: Yes)
Actemra (subcutaneous)	162 mg = 4 prefilled syringes/month (Overrides: No)
Repatha	140 mg = 2 syringes/pens per month (Overrides: Yes)
Dupixent	100 mg = 2 prefilled syringes per 62-unit pack (Override: No); 200/300 mg = 2 prefilled syringes/pens per 62-unit pack (Override: Yes)
Saxenda	1 = 5 pens; two one-month fills required before a three-month fill may be allowed (Overrides: No)
Wegovy	31-day supply = 4 pens; two one-month fills required before a three-month fill may be allowed (Overrides: Yes)
Relistor	8 mg/0.4 mL, 12 mg/0.6 mL = 28 syringes; 150 mg = 90 tablets
Revlimid	2.5–15 mg = 28 capsules; 20/25 mg = 21 capsules
Saxenda (prereq)	Two one-month fills required before a three-month fill is available

Medication-level placeholdersNDC

(placeholder)

Medication-level code table placeholder — see supply mappings for product-specific limits

Supply mapping examples (strength -> max supply)mixed

Repatha - 140 mg	2 syringes/pens per month
Dupixent - 200/300 mg	2 prefilled syringes/pens per 62-unit period
Actemra SC - 162 mg	4 prefilled syringes/month
Saxenda/Wegovy (injectables)	31-day supply = 4 pens; multi-fill prerequisite may apply (see rules)
Relistor (injectable)	8/12 mg syringes = 28 syringes/month

Example thresholds

Example supply limit format

Example supply-limit mappings (medication => max quantity/timeframe)

Multi-fill prerequisite examples

Overrides, Authorization, and Plan Applicability

Prior Authorization

Overrides / Authorization flags may be indicated

List indicates whether Overrides (i.e., override/authorization) are Yes or No for many products; inclusion does not guarantee coverage and drugs may be subject to other requirements such as Exclude at Launch and/or Review at Launch.

Billing Rule

Supply limits set maximum covered quantities

Supply Limits establish the maximum quantity of drug that is covered in a copay or a specified timeframe. Inclusion in this list does not indicate a drug is covered by a particular plan; additional plan requirements may apply.

Terms and Notes

inv-19: Supply Limits — definition identifier

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

Scope noteApplies to medications listed with duration-based quantity caps; does not itself determine coverage eligibility for a specific plan.

Related requirementsDrugs included may still be subject to other requirements such as Exclude at Launch or Review at Launch.

inv-20: Overrides — indicates whether an override or additional authorization may be permitted

Override flag meaningOverrides = Yes/No indicates whether an override or additional authorization may be permitted for the listed quantity limit.

How presentedOverride status is listed per product row (e.g., 'Abilify Discmelt ... Overrides = Yes').

Policy Summary

PayerUnitedHealthcare

PolicyMedication supply quantity limits (duration quantity limits)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateFor 5/1/2026 Effective Date

Next Review DateN/A

Key ActionCheck the listed medication entries for per-product quantity limits and override (Yes/No) flags when determining plan coverage eligibility.

SourceLink

On This Page

Example per-drug supply limits

Note

Inclusion does not guarantee plan coverage

Inclusion of a medication in the Supply Limits list does not indicate it is covered by a particular plan; drugs may be subject to other requirements including Exclude at Launch or Review at Launch.

Documentation Required

Provider notice: verify plan applicability before dispensing

Supply Limits establish maximum quantities covered per copay or timeframe, but applicability depends on the member's specific plan and other utilization management rules.

Check member’s plan for Exclude at Launch or Review at Launch status before assuming coverage.
A listed quantity limit may be overridden only where the plan permits an override (Yes/No flags shown per product).

Billing Rule

Definition — Supply Limits

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

Coverage disclaimerEven if Overrides = Yes, inclusion on the list does not guarantee coverage; plan-specific rules apply.

inv-21: Supply Limits — additional reference entry

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

Document roleThis list provides duration/quantity limits and equivalencies (e.g., pack-to-tablet mappings) for many products.

Plan applicabilityInclusion does not indicate the drug is covered by a particular plan; additional utilization controls may apply.

inv-22: Coverage implication — inclusion does not indicate coverage; other policies may apply

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

Operational noteProviders should verify plan-specific coverage and prior authorization requirements beyond the supply limit list.

DocumentationThe list repeatedly states the inclusion disclaimer alongside supply limit entries (see multiple chunks).

inv-23: Supply Limits — repeated definition references

Supply Limits (repeat)Supply Limits: the maximum quantity of drug covered in a copay or specified timeframe (reiterated throughout the document).

List persistenceThe definition and disclaimer are repeated at the top of each section/page (Last updated 4/22/2026; Effective 5/1/2026).

Review requirementSome entries explicitly call out 'Requires Supply Limit Review' for specific strengths/products.

inv-24: Coverage implication note — repeated coverage applicability caution

Coverage note repeatThe document repeatedly cautions that inclusion does not indicate coverage and other requirements may apply.

Advice to check plan rulesConfirm plan-level coverage, prior authorization, and Exclude/Review at Launch statuses before assuming coverage based on list membership.

Overrides contextOverride flags appear per-row and may not override other plan-specific exclusion rules.

inv-25: Supply Limits — restated definition for clarity

Definition claritySupply Limits establish the maximum quantity of drug that is covered in a copay or a specified timeframe (clarified in multiple locations).

FormatEntries pair product/strength with a quantity/timeframe and an Overrides flag (Yes/No).

Provider actionProviders should treat the list as a supply-quantity reference, not a standalone coverage determination.

inv-26: List inclusion note — inclusion does not indicate coverage and other requirements may apply

Inclusion caveatInclusion on the supply-limit list does not indicate coverage; products may be subject to Exclude at Launch or Review at Launch.

Overrides may not sufficeEven when Overrides = Yes on a row, other plan-level exclusions or reviews may still prevent coverage.

Verify per-plan rulesCheck the member's plan and any additional utilization management requirements before prescribing or dispensing.

inv-27: Supply Limits / duration quantity limit — restated definition

Duration/quantity definitionSupply Limits / duration quantity limit: establishes the maximum quantity of drug that is covered in a copay or a specified timeframe.

Examples presentDocument shows duration-based mappings such as 60 sublingual tablets = 1 device/2 months or 60 sublingual tablets = 84 tablets depending on product.

Usage guidanceUse these duration quantity entries as the covered maximum supply reference; confirm coverage and refill rules per plan.