Quantity Limits

Quantity limits are restrictions placed on the amount of certain medications that TRICARE will cover within a given time period. These limits are based on FDA-approved dosing guidelines and clinical best practices to promote safe and appropriate medication use.

How quantity limits work: • Each affected medication has a maximum quantity per fill period • Retail pharmacies: Limits typically based on a 30-day supply • Home delivery: Limits typically based on a 90-day supply • Exceeding the limit requires prior authorization or an exception

Common reasons for quantity limits: • Safety concerns with high doses or prolonged use • FDA-approved dosing guidelines • Risk of medication misuse • Cost management for high-cost drugs

Requesting quantity limit exceptions: • Your provider must submit a prior authorization request • Clinical justification for exceeding the limit must be provided • Express Scripts reviews and approves or denies the request • Approved exceptions are typically valid for a specified period

If your prescribed quantity exceeds TRICARE's limit, work with your provider to either adjust the prescription or submit an exception request through Express Scripts.