UnitedHealthcare Community Plan Quantity Limit Policy
UnitedHealthcare Community Plans may have monthly quantity limitations on certain medications. Prescriptions for quantities greater than the indicated monthly limits will require prior authorization. Quantity limits exist to promote efficient medication dosing and safe dosing administration.
Quantity limits also apply to certain classes of medications. Patients have access to any FOUR medications from the following classes in a 30-day period: opiate analgesics, benzodiazepines, sedative hypnotic agents, barbiturates, and select muscle relaxants. Additional fills will require prior authorization. Medications in these classes may also be subject to individual quantity limits.
Additions to the Quantity Limit (QL) program drug list will be made from time to time and providers notified accordingly. As always, we recognize that a number of patient-specific variables must be taken into consideration when drug therapy is prescribed and therefore overrides will be available through the prior authorization (PA) process.
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On September 1, 2021, the TennCare pharmacy program released, for the first-time, a 90-day prescription drug list of low-cost, maintenance medications. This new 90-day prescription drug list will give providers the option to prescribe and dispense quantities of up to 90 days for the medications included on the list. It should also be noted that members will only have to pay one co-payment for the 3-month supply. United Healthcare would like to ensure that all care coordinators and member facing staff are aware of this information and can access the current list, so that our members are well-informed of the benefits of 90-day prescription fills/refills.
Please keep the additional resources available below on-hand, to ensure you have the most current 90-day drug list.