Coverage Limits & Additional Requirements

Coverage Limits & Additional Requirements

For certain prescription drugs, we have additional requirements or coverage limits. These requirements ensure that our members use their drugs in the most cost effective way and help us control costs. These requirements, developed by a team of doctors and pharmacists, help us provide quality coverage to our members.

Prior Authorization

We require prior authorization for certain drugs. Your physician or provider will help you get approval from us before you fill your prescription. If they don't get approval, we may not cover the drug.

Quantity Limits

For certain drugs, we limit the amount we will cover per prescription for a defined period of time. For example, we provide up to 60 pills in a 30-day period for Celebrex.

Generic Substitution

When there is a generic version of a brand-name drug available, our network pharmacies automatically give you the generic version.

See our drug list to find out which drugs are subject to these additional requirements. You can ask us to make an exception if one of your drugs has additional requirements. See How to request an exception for more information.

Y0010_MK18060 Approved 10/19/2017
Last updated 10/01/2017