- prescription drugs
- Drug Coverage Limits
Drug Coverage Limits
Your plan covers the drugs in our list as long as:
- The drug is medically necessary, meaning you need it to treat a condition you have
- You and your provider follow all the rules around prescription drugs
Keep in mind that some prescription drugs may have limits on their coverage, such as:
- Prior authorization (PA). This means your provider has to check with us first to make sure we'll cover the drug.
- Quantity limits (QL). With some drugs, you’re covered for only a limited amount of medicine — or for a set length of time. These are called quantity limits. For example, you might only be covered for 30 pills in one month.
- Step therapy (ST). Before you can get certain drugs, you first need to try one that costs less and typically works for your condition. If the lower cost drug doesn’t help, then you can step up to the more expensive one.
- Opioid rules. To help address the opioid crisis, the Centers of Medicare and Medicaid Services (CMS) created new rules for opioid prescriptions. Learn how these rules could affect you.
If you have any questions — or you can't find your medications in our list — give us a call at 1-800-DEVOTED (1-800-338-6833), TTY 711.