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June 2019
Stimulant drugs will have new quantity limits starting July 1, 2019
On July 1, 2019, Blue Cross Blue Shield of Michigan will implement new quantity limits for stimulant drugs, as shown in the table below. This change only affects our commercial (non-Medicare) members who have Blue Cross pharmacy benefits.
Our goal is to provide our members with safe, high-quality prescription drugs. In May, we sent letters to notify members who may be affected by these quantity limit changes. The letters encourage members to discuss treatment options with their physicians.
If necessary, you can request an override of the quantity limits for your patients. The request should include documentation stating that the amount you’re prescribing is medically necessary.
To get a form for a quantity limit override, log in as a provider at bcbsm.com/providers or call the Pharmacy Services Clinical Help Desk at 1-800-437-3803 and select Option 1.
Here are quantity limits for stimulant drugs, effective July 1, 2019:
Drug name
(generic name)
|
Strength |
Quantity covered |
Concerta
(methylphenidate tablet extended release) |
18mg, 27mg, 36mg, 54mg |
2 tablets/day |
Daytrana
(methylphenidate transdermal patch) |
10mg/9hr, 15mg/9hr, 20mg/9hr, 30mg/9hr |
1 patch/day |
Desoxyn
(methamphetamine tablet) |
5mg |
5 tablets/day |
Dexedrine
(dextroamphetamine sulfate capsule extended, dextroamphetamine tablets) |
5mg, 10mg, 15mg |
4 tablets or capsules/day |
Focalin
(dexmethylphenidate tablet) |
2.5mg, 5mg, 10mg |
3 tablets/day |
Focalin XR
(dexmethylphenidate capsule extended release) |
5mg, 10mg, 15mg, 20mg, 25mg, 30mg, 35mg, 40mg |
2 capsules/day |
Metadate CD ≤ 30 mg
(methylphenidate capsule extended release) |
10mg, 20mg, 30mg |
3 capsules/day |
Metadate CD > 30 mg
(methylphenidate capsule extended release) |
40mg, 50mg, 60mg |
2 capsules/day |
Methylin
(methylphenidate chewable tablet) |
2.5mg, 5mg, 10mg, 20mg |
7 tablets/day |
Methylin Er / Metadate ER
(methylphenidate tablet extended release) |
10mg, 20mg |
6 tablets/day |
Methylin Solution
(methylphenidate solution) |
5mg/5ml, 10mg/5ml |
80mg/day |
Procentra
(dextroamphetamine solution) |
5mg/5ml |
60mg/day |
Ritalin
(methylphenidate tablet) |
5mg, 10mg, 20mg |
7 tablets/day |
Ritalin LA ≤ 30 mg
(methylphenidate capsule extended release) |
10mg, 20mg, 30mg |
4 capsules/day |
Ritalin LA 40 mg
(methylphenidate capsule extended release) |
40mg |
3 capsules/day |
Ritalin LA 60 mg
(methylphenidate capsule extended release) |
60mg |
2 capsules/day |
Ritalin SR
(methylphenidate tablet sustained release) |
20mg |
6 tablets/day |
Strattera
(atomoxetine capsule) |
10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg |
2 capsules/day |
Zenzedi
(dextroamphetamine tablet) |
2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg |
4 tablets/day |
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