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Utilization management (UM) restrictions on
prescription drug coverage.
Some covered drugs may have requirements or limits on coverage. These requirements and limits may include:
- Prior Authorization - Part B versus Part D (B/D): indicates that this drug may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.
- Limited Access (LA): This prescription may be available only at certain pharmacies.
- Mail-Order Drug (MO):This prescription drug is available through our mail-order service.
- Non-Extended Day Supply (NEDS): This prescription cannot be filled for more than a 30-day supply.
- Prior Authorization (PA): requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from Zing before you fill your prescriptions. If you don’t get approval, Zing may not cover the drug.
- Quantity limit (QL): For quality and safety reasons, certain drugs have a limit on the amount you can get at one time. For example, a medication may have a limit of 30 tablets in 30 days.
- Step Therapy (ST): Some drugs require you to try a less expensive drug first. Medications with step therapy have at least one comparable medication that you must try first.