Quantity limits are designed to limit the use of selected drugs for quality and safety reasons. The quantity limit for each drug is supported by drug studies and by actively practicing doctors. This utilization management program encourages appropriate drug use to assist in reducing drug benefit costs for everyone.
Affected drugs will be marked with QL on the member's Preferred Medication List and may change quarterly. The prescription drug card program includes these quantity limit programs:
- Drugs used in acute migraine headache therapy
- Drugs treating erectile dysfunction
- OxyContin® (oxycodone)
- Topical and injectable androgens and anabolic steroids
- Ampyra™, a multiple sclerosis medication
- Specialty medications Firazyr® and Kalydeco™
The selected drugs used in migraine headache therapy are designed to be taken when a migraine attack occurs. Some patients begin to take these drugs in anticipation of a headache. When used too often, these medications can actually cause headaches. The overuse of the selected drugs for every headache can be unsafe. Patients are encouraged to talk to their doctor about other treatments for migraine headaches, or about drugs to prevent the headache if patients experience migraine attacks more often than six days a month.
OxyContin is a controlled-release tablet indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time. OxyContin is not intended for use on an as-needed basis. OxyContin has been associated with numerous reports of diversion and abuse, some resulting in death.
Quantities over the limit will not be paid under members' prescription drug benefit. Members may purchase additional quantities, but this cost will not be reimbursed by BCBSKS.