The Maryland Medicaid Pharmacy Program maintains dose limitations on some medications. These limits are based on the manufacturers’ recommended dosing found in the product labeling. Quantity Limits are in place to promote safe and appropriate use of medication and contain costs. Quantity limits include:

  • Dose efficiency edits – Limits coverage of prescriptions to one dose per day for drugs that are approved for once-daily dosing.
  • Maximum daily dose – A message is sent to the pharmacy if a prescription is less than minimum or higher than the maximum allowed dose.
  • Quantity limits over time – Limits coverage of prescriptions to a specific number of units in a defined amount of time.
  • Dose optimization – For drugs whose different strengths all have the same or nearly the same unit cost, limits require using the highest possible strength rather than multiple units of lower strengths.

To get prescription coverage for amounts that are over the allowed quantity, a prescriber must request prior authorization by calling 800-932-3918 and completing and faxing a PA Request Form.

Call 800-932-3918 or click here for a table showing the specific limitations for obtaining quantities in excess of those listed, if clinically indicated.

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