Plan Options

MedicareBlue PPO (Regional PPO)

Quantity Limits

MedicareBlue PPO (Regional PPO) covers a 31-day supply for retail prescriptions (or up to a 90-day supply at certain retail pharmacies or through mail order). In addition, some prescriptions are limited to a specified maximum quantity. Amounts over this quantity are not a covered benefit unless approved in advance by the plan.

Quantity limits are in place for these drugs to ensure the medication is being used correctly and other treatments are not more appropriate. Most people would not need to take these drugs more often than what is allowed.

No special steps are necessary by the physician or member to have these drugs covered as long as the medications are prescribed within the limitations. If you require one of these drugs in a larger quantity than is allowed, your physician may request an exception to have a larger quantity of the drug covered. An exception is a type of coverage determination. For more information, follow the link to find the Coverage Determination/Redetermination form.

You may search the drug formulary now to find out if your drug has a quantity limit.

September 10, 2010

Important Information

This page last updated and accepted by CMS July, 2010.

MedicareBlue Rx (PDP) is a Medicare-approved Part D sponsor. MedicareBlue PPO (Regional PPO) is a Medicare-approved regional PPO plan.

Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*

*Independent licensees of the Blue Cross and Blue Shield Association.