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of the Commonwealth of Pennsylvania

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    Pharmacy Services

    Fee-for-Service Quantity Limits/Daily Dose Limits

    The Medicaid Fee-for-Service (FFS) quantity limits and daily dose limits apply to prescriptions for Medicaid beneficiaries whose pharmacy services are covered by the Fee-for-Service program (i.e., ACCESS).

    The limits are based on FDA-approved package labeling, medical compendia, and current peer-reviewed medical literature. Prescriptions that exceed the established limits will require prior authorization before the prescription may be dispensed.

    Please refer to Quantity Limits/Daily Dose Limits for the list of drugs that are subject to quantity limits/daily dose limits. This list is alphabetical by brand name. Refer to Pharmacy Prior Authorization Clinical Guidelines for the guidelines to determine the medical necessity of prescriptions that exceed the FFS quantity limits/daily dose limits.

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