Certain programs are in place to ensure prescription drugs are covered appropriately under the prescription drug program.

To help you get the medications you need safely and affordably, Express Scripts and Kaiser limit the amount of certain prescription drugs you can have filled at one time. This ensures that you receive the medications you need in the quantity considered safe.

Quantity limits also help you save money. If your medicine is available in different strengths, you might take one dose of a higher strength instead of two or more doses of a lower strength – saving you money since you pay for fewer dosage units.

For example, if you take a medication that requires two 10 milligram pills a day for a month, that equals 60 pills for a 30-day supply. Because you can only get up to 50 pills for a 30-day supply based on quantity limits, you would be limited to a 25-day supply. This means you would need to fill your prescription more frequently to get the prescribed dosage for the entire month. As an alternative, you could take one 20 milligram pill and split the pill in two, which equals only 30 pills for a 30-day supply.

There are also drugs that have a quantity limit in place regardless of where you obtain your medication. This list of drugs is subject to change. Please verify with Express Scripts or Kaiser to confirm the status and eligibility of a drug.

Prior authorization (PA) is required for certain medications prior to use or when exceeding recommended quantities. The selected drugs will not be filled at the point of service until the medication use has been approved. Aetna will conduct an evaluation to determine if the patient meets the defined guidelines for use of the medication. You are required to have your physician contact Express Scripts or Kaiser to provide information necessary for the evaluation. Once a patient is approved, normal claims processing will occur.

Prior authorizations promote appropriate prescribing of prescription drugs. For the most current information on the prescription drugs that require prior authorization under the program, please visit www.express-scripts.com or https://healthy.kaiserpermanente.org/.

For the most current information on the types of drugs that are not covered under the program, please visit www.express-scripts.com or https://healthy.kaiserpermanente.org/. This list may change at any time.