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Drugs With Quantity Limits

Blue Cross of Idaho limits the quantity of certain drugs given to members due to safety concerns. The list of drugs with a quantity limit or gender restriction includes:

Updated November 2013

Acetaminophen and/or drugs that contain Acetaminophen 4000 mg daily dosage limit per the recommendation of the FDA to decrease the occurrence of Acetaminophen Hepatotoxicity
Anti-Emetic: Zofran (ondansetron) 120 tablets per 30-day supply
Anti-Emetics: Anzemet (dolasetron), Cesamet (nabilone, Emend (aprepitant), Kytril (granisetron), and Sancuso (granisetron) Transdermal Patch

15 tablets/capsules per 30-day supply

2 patches per 30-day supply

Exception: Any prescription written by an oncologist.

Anti-Emetic: Marinol (dronabinol) 90 capsules per 30-day supply

Arthritis: Arava (leflunomide)

30 day supply

Antimalarial: Lariam (mefloquine)

8 pills per 30-day supply

Depression: Prozac Weekly (fluoxetine 90 mg)

8 pills per 30-day supply

Migraine: Alsuma (sumatriptan), Amerge (naratriptan), Axert (almotriptan), Frova (frovatriptan), Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan), Zomig (zolmitriptan)

Tablets: 18 per 30-day supply at retail or 54 per 90-day supply at mail order.

Imitrex Nasal Spray: 6 per 30-day supply. 
Zomig Nasal Spray: 6 per 30-day supply.

Imitrex Injectable: 6 per 30-day supply.

NSAID: Toradol (ketorolac)

Oral Toradol is FDA approved as a continuation of injectable Toradol. Maximum dose per day is 40 mg. Quantity limit is 16 tablets within 5 days.

Boniva (ibandronate)
Fosamax 35mg (alendronate)
Fosamax 70 mg (alendronate)
Fosamax Plus (alendronate plus D)

1 pill per 30-day supply
8 pills per 28-day supply
4 pills per 28-day supply
4 pills per 28-day supply

Prostate: Proscar (finasteride)

Limited to men ONLY

Sexual Dysfunction: Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil)

6 per 30-day supply. Limited to men ONLY (when a covered benefit)

Sleep Agents (Hypnotics): Ambien (zolpidem), Dalmane (flurazepam), Lunesta (eszopiclone), Halcion (triazolam), ProSom (estazolam), Restoril (temazepam), and Sonata (zaleplon)

(Ambien CR (zolpidem ER) if approved for coverage)

Limit of 1 tablet/capsule per day

Tobacco Cessation: Chantix (varenicline)

Limited to a 90 day supply or the maximum per contract when a covered benefit.

*This list is subject to change.

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