Drug Quantity Management
To make sure your prescriptions stay safe, effective and affordable, the PSSU Health and Welfare Fund prescription plan will now include a Drug Quantity Management program. This means that for certain prescription drugs our plan will limit the amount that you receive at one time.
First, the program promotes safety. It makes sure you receive the medication you need in the quantity considered safe. That is, you get the right amount to take the daily dose considered safe and effective, according to guidelines from the U.S. Food & Drug Administration (FDA) and medical studies.
Second, the program helps 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 of a lower strength. This saves money because you pay for fewer doses. For instance, you might need 40 mg of a medication every day. If you take two pills a day at 20 mg, you would need to get two supplies — and pay two copayments — every month. With your doctor’s approval, you might be able to take a 40 mg pill once a day. One supply would last you a full month, and you have just one copayment.
The program also controls the cost of “extra” supplies of medication that could go to waste in your medicine cabinet. For instance, you might buy a supply of a medication. But if your doctor changes the prescription, some of the medication could be wasted.
What drugs are included in the program?
Drugs that could have safety issues for you if the quantity is greater than guidelines recommend — for instance drugs that aren’t easily measured out, like nose sprays or inhalers.
Drugs that come in several strengths — because if you can take fewer doses at a higher strength, you save on your copayments. To see if any of your prescriptions are affected by this change, look at our plan’s list of drugs in the program.
How does the program work?
When you need a refill, your pharmacist might say that you’re asking for a refill too soon; that is, you should still have some of your medication on hand. In this case, simply ask your pharmacist when you can get your next refill. But if your prescription is written for a larger amount than your plan covers:
You can ask your pharmacist to give you the amount that your plan covers. You’ll pay the appropriate copayment each time. Or, your pharmacist can ask your doctor to change your prescription to a higher strength, when one is available. This way, you meet your plan’s quantity limit, you get the daily dose you need and you have fewer copayments. Or, if your doctor doesn’t agree with the limit, he or she can call Express Scripts to request a “prior authorization,” which may let you get a greater quantity. Quantity limits can help you get the prescription drugs you need safely and affordably. If you have questions, please contact Express Scripts at the number on your ID card.
Who developed my Drug Quantity Management program?
The program follows guidelines developed by the U.S. Food & Drug Administration (FDA). These guidelines recommend the maximum quantities considered safe for prescribing certain medicines.
Together with Express Scripts — the company that manages your pharmacy benefit — your plan develops your Drug Quantity Management program based on FDA guidelines and other medical information.