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Quantity Dispensing Limits (QL) Table

August 3, 2007

Quantity Dispensing Limits (QL)

Class

Agents affected

Dispensing Limit per month

Triptans

Amerge® (naratriptan)
Axert® (almotriptan)

Frova® (frovatriptan)

Imitrex® (sumatriptan)

Maxalt® (rizatriptan)

Relpax® (eletriptan)

Zomig® (zolmitriptan)

18 total units per month

12 total nasal inhalation units per month

4 total injection kits per month

Aldosterone Antagonist

Inspira™ (eplerenone)

25 mg [68 tablets]
50 mg [34 tablets]

Non-benzodiazepine hypnotics

Ambien® (zolpidem)
Ambien CR®
Sonata® (zaleplon)
Rozerem (ramelteon)
Lunesta (eszopiclone)

5 mg [30 tablets]; 10 mg [60 tablets]
30 tablets
60 tablets
30 tablets
30 tablets

Other

Lyrica (pregabalin)

25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg [90 tablets]
300 mg [60 tablets)

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