Quantity Limits definition

Quantity Limits. For certain drugs, we limit the amount of the drug that we will cover per prescription or for a defined period of time. For example, we will provide up to 9 doses per defined prescription period (i.e., per 30-day period) for IMITREX tablets.
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Examples of Quantity Limits in a sentence

  • Buyer’s final quantity nomination, by month, to be provided by Buyer to Seller on or before October 1st which shall be considered the Contract Quantity for the next Nomination Period (pursuant to Section 4.1 of the Base Contract), must be within the Contract Quantity Limits and shall establish the delivery and acceptance obligations of the parties for such Nomination Period, subject to excuse due to Force Majeure or other adjustments as set forth herein.

  • For the Contract Year 2013, Buyer projects the Contract Quantity Limits to be between **** tons and **** tons.

  • Days Supply Days Supply may be less than the amount shown due to Prior Authorization, Quantity Limits, and/or age limitation and Utilization Guidelines Retail Pharmacy (Participating & Non-Participating) 30 Mail Service 90 Tier 4 Drugs 30* *Some Tier 4 drugs may be available in 90 day supply via mail service.

  • Table 5 Measures to Control Costs during CY 2021 Utilization Management Prior Authorization Yes Step Therapy Yes Quantity Limits Yes Pharmacy Networks Yes Preferred Drug List Yes ProDUR Activities Yes The overall drug rebate process follows the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) as codified in Section 1927 of the Social Security Act (42 U.S.C. 1396r-8) and regulations promulgated by the Centers for Medicare & Medicaid Services (CMS).

  • We cover drugs on the Covered Drug List (formulary), as long as: ● The drug is Medically Necessary and ● The prescription is filled at one of our Network pharmacies and ● Other Plan rules are followed where applicable, including but not limited to: Prior Authorization, Quantity Limits and Step Therapy.

  • RX Quantity Limits, Step Therapy Required (will also be included in a summary sheet prepared by consultant).

  • Quantity Limits The PBM is required to provide a limitation program for drugs which are indicated only for a specific therapeutic period or are limited to certain amounts.

  • Options for Increased Quantities The Buyer may increase the quantities of Services called for in Schedule A by up to 50% of the "QTY" (Quantity) Limits specified therein, at the costs and/or prices contained in the Rate Tables that are a part of Schedule A.

  • Please refer to the US Settlements & Confirmations MP v37.1 for recommendations on Settlement Quantity Limits and ‘splitting’ responsibility.

  • These requirements and limits may include: Prior Authorization, Quantity Limits, and Step Therapy.