Glossary
Quantity limit
In one sentence
A cap on how much the plan will pay for in a given period. It bites on GLP-1s during dose escalation, where the prescribed titration can outrun the quantity the plan will release.
Also written as QL, Dispensing limit.
What quantity limit actually means
A quantity limit does not say no to the drug. It says no to the amount, which produces a denial that looks like a coverage denial and is not one. The fix is usually a different filing from the one a coverage denial calls for.
It is the third of the three tools Medicare's rules name together, and it changes on the same footing as the other two. Where a state or plan publishes its limit, we quote the number on that page rather than describing it, because a quantity limit is exactly the sort of figure that moves.
The text it comes from
This is the wording the definition rests on. Where it decides anything for you, read the section rather than our summary of it.
Quantity limits are named in Medicare's rules beside prior authorization and step therapy, and tightening one is tracked as a negative formulary change: "Adding or making more restrictive prior authorization (PA), step therapy (ST), or quantity limit (QL) requirements."
42 CFR §423.100, Electronic Code of Federal Regulations, effective August 2026 · source
Where this comes from
- 42 CFR §423.100, Electronic Code of Federal Regulations, effective August 2026 — www.ecfr.gov/current/title-42/part-423/section-423.100
Where this comes up
American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page says what a published rule means by a word. Which rulebook governs you depends on your plan, and your own notice and plan documents govern your case.