Drug Quantity Management Drug List

Based on FDA recommended prescribing and safety information, our Quantity Management rules ensure that our members are receiving the most clinically effective dosages of medication (treatment endpoints and frequency).

Physicians can call Express Scripts at (800) 753-2851.

Express Scripts Drug Quantity Management (DQM) List

Effective July 1, 2017

Targeted DrugsMost Common Indication
Actoplus Met XRDiabetes
AdcircaPulmonary Hypertension
AdlyxinDiabetes
Advair DiskusAsthma/COPD
Advair HFAAsthma/COPD
AdvicorHigh Blood Cholesterol
AerospanAsthma/COPD
AfinitorOncology
AirduoAsthma/COPD
AkynzeoNausea/Vomiting
AlecensaOncology
alendronateBone Conditions
alendronate sodiumBone Conditions
almotriptan malateMigraine Headaches
AloxiNausea/Vomiting
AltoprevHigh Blood Cholesterol
AlvescoAsthma/COPD
amlodipine-atorvastatinHigh Blood Cholesterol
Anoro ElliptaAsthma/COPD
AnzemetNausea/Vomiting
Aplenzin ERDepression
ArcaptaAsthma/COPD
aripiprazoleMental/Neurological Disorders
Arnuity ElliptaAsthma/COPD
AsmanexAsthma/COPD
Asmanex HFAAsthma/COPD
atorvastatin calciumHigh Blood Cholesterol
Atrovent HFAAsthma/COPD
AustedoMental/Neurological Disorders
AvandametDiabetes
AvandarylDiabetes
AvandiaDiabetes
azacitidineOncology
BelbucaPain - Narcotic
BelsomraSleep Disorder
BethkisAnti-infective - Specialty
BinostoBone Conditions
BosulifOncology
Breo ElliptaAsthma/COPD
BrintellixDepression
BrisdelleDepression
Brovana Inhalation SolutionAsthma/COPD
BudesonideAsthma/COPD
BunavailPain - Narcotic
bupropion HCLDepression
butorphanol tartrateMigraine Headaches
ButransPain - Narcotic
BydureonDiabetes
Bydureon PenDiabetes
ByettaDiabetes
cabergolineEndocrine Disorder
CabometyxOncology
CambiaMigraine Headaches
CaprelsaOncology
Cardura XLHigh Blood Pressure
CaverjectImpotence
Caverject ImpulseImpotence
CaystonAnti-infective - Specialty
CesametNausea/Vomiting
CholbamEndocrine Disorder
CinryzeHereditary Angioedema
citalopram hydrobromDepression
clondineHigh Blood Pressure
CombiventAsthma/COPD
Combivent RespimatAsthma/COPD
Conzip ERPain
CotellicOncology
CrestorHigh Blood Cholesterol
DaklinzaHepatitis C
desvenlafaxine ERDepression
diclofenac sodiumPain
DificidAnti-Infective
dihydroergotamine MEMigraine Headaches
doxazosin mesylateHigh Blood Pressure
DuleraAsthma/COPD
duloxetine HCLDepression
DupixentInflammatory Condition
EdexImpotence
EdluarSleep Disorder
EmbedaPain - Narcotic
EmendNausea/Vomiting
Emend Trifold PackNausea/Vomiting
EntrestoHeart Failure
EpclusaHepatitis C
ErbituxOncology
ErivedgeOncology
escitalopram oxalateDepression
eszopiciloneSleep Disorder
EuflexxaHyaluronic Acids
EvzioPain - Narcotic
Exalgo ERPain - Narcotic
famciclovirAnti-infective
FanaptMental/Neurological Disorders
Fanapt Titration PackMental/Neurological Disorders
FarxigaDiabetes
FarydakOncology
Fetzima ERDepression
Fetzima ER Titration PackDepression
FirazyrHereditary Angioedema
FlectorPain
Flovent DiskusAsthma/COPD
Flovent HFAAsthma/COPD
fluconazoleAntifungal
fluoxetine HCLDepression
fluvastatin sodiumHigh Blood Cholesterol
fluvoxamine maleateDepression
Foradil AerolizerAsthma/COPD
Forfivo XLDepression
ForteoBone Conditions
Fosamax Plus DBone Conditions
Fosamax SolutionBone Conditions
frovatriptan succinateMigraine Headaches
GilotrifOncology
GlyxambiDiabetes
granisetron HCLNausea/Vomiting
HarvoniHepatitis C
HetliozSleep Disorder
HumiraInflammatory Conditions - Specialty
HyalganHyaluronic Acids
HysinglaPain - Narcotic
ibandronateBone Conditions
IbranceOncology
imatinib mesylateOncology
ImbruvicaOncology
InclusigOncology
Incruse ElliptaAsthma/COPD
IngrezzaMental/Neurological Disorders
InlytaOncology
Invega ERMental/Neurological Disorders
InvokametDiabetes
InvokanaDiabetes
Ipratropium InhalerAsthma/COPD
IressaOncology
IstodaxOncology
itraconazoleAntifungal
JakafiOncology
JanumetDiabetes
Janumet XRDiabetes
JanuviaDiabetes
JardianceDiabetes
JentaduetoDiabetes
JevtanaOncology
JuvisyncDiabetes
KadianPain - Narcotic
KazanoDiabetes
ketorolac tromethaminePain
KhedezlaDepression
KisqaliOncology
Kitabis PakAnti-infective - Specialty
Kombiglyze XRDiabetes
LamisilAntifungal
LatudaMental/Neurological Disorders
leflunomideInflammatory Conditions
LetairisPulmonary Hypertension
Lidocaine OintmentTopical Pain
Lidocaine PatchPain
linezolidAnti-Infective
LiptruzetHigh Blood Cholesterol
LivaloHigh Blood Cholesterol
lovastatinHigh Blood Cholesterol
Luvox CRDepression
LyricaMental/Neurological Disorders
Maxair AutohalerAsthma/COPD
MekinistOncology
MeloxicamPain
Ms ContinPain - Narcotic
MuseImpotence
naratriptan HCLMigraine Headaches
NarcanPain - Narcotic
NebupentAnti-infective
NesinaDiabetes
NexavarOncology
NinlaroOncology
NoxafilAnti-Infective
NucalaAsthma Specialty
NucyntaPain - Narcotic
NuedextaMental/Neurological Disorders
OdomzoOncology
olanzapineMental/Neurological Disorders
OlysioHepatitis C
omega-3 acid ethyl estersHigh Blood Cholesterol
OndansteronNausea/Vomiting
Ondansteron HCLNausea/Vomiting
Ondansteron ODTNausea/Vomiting
OnglyzaDiabetes
OnmelAntifungal
Oramorph SrPain - Narcotic
OrenciaInflammatory Conditions
OrkambiRespiratory/Miscellaneous
OseniDiabetes
OxycontinPain - Narcotic
paroxetine HCLDepression
PegasysHepatitis C
Pegasys ProclickHepatitis C
PegintronHepatitis C
Pegintron RedipenHepatitis C
Pennsaid SolutionAntifungal
PerforomistAsthma/COPD
PexevaDepression
pioglitazone HCLDiabetes
pioglitazone HCL/METDiabetes
pravastatin sodiumHigh Blood Cholesterol
PristiqDepression
Pristiq ERDepression
Proair HFAAsthma/COPD
Proair RespiclickAsthma/COPD
ProliaMultiple Sclerosis
Proventil HFAAsthma/COPD
Pulmicort FlexhalerAsthma/COPD
quetiapine fumarateMental/Neurological Disorders
QvarAsthma/COPD
RanexaAnti-Anginal
RelenzaAnti-influenza
repaglinide/metforminDiabetes
RevatioPulmonary Hypertension
RevlimidOncology
RexultiMental/Neurological Disorders
risedronate sodiumBone Conditions
risperidoneMental/Neurological Disorders
rizatriptan benzoateMigraine Headaches
RozeremSleep Disorder
RubracaOncology
Rybix OdtPain
SamscaEndocrine Disorder
SancusoNausea/Vomiting
SaphrisMental/Neurological Disorders
SarafemDepression
SavellaDepression
Savella Titration PackDepression
Seebri NeohalerAsthma/COPD
Serevent DiskusAsthma/COPD
Seroquel XRMental/Neurological Disorders
sertraline HCLDepression
sildenafil citratePulmonary Hypertension
SilenorSleep Disorder
SimcorHigh Blood Cholesterol
SimponiInflammatory Conditions
simvastatinHigh Blood Cholesterol
SitavigAnti-infective
SoliquaDiabetes
SovaldiHepatitis C
SpirivaAsthma/COPD
Spiriva RespimatAsthma/COPD
SprixPain
SprycelOncology
StelaraInflammatory Conditions
Stiolto RespimatAsthma/COPD
StivargaOncology
Striverdi RespimatAsthma/COPD
SuboxonePain - Narcotic
sumatriptanMigraine Headaches
Sumatriptan SuccinateMigraine Headaches
Sumavel DoseproMigraine Headaches
SupartzHyaluronic Acids
SutentOncology
SymbicortAsthma/COPD
SymlinpenDiabetes
SynjardyDiabetes
Synjardy XRDiabetes
Synvisc, Synvisc-OneHyaluronic Acids
TafinlarOncology
TagrissoOncology
TamifluAnti-influenza
TanzeumDiabetes
TarcevaOncology
TasignaOncology
Technivie Dose PackHepatitis C
terazosin HCLHigh Blood Pressure
TivorbexPain
Tobi PodhalerAnti-infective - Specialty
tobramycin IN 0.225% NACLAnti-infective - Specialty
ToradolPain
TradjentaDiabetes
tramadol acetaminophenPain
Tramadol HclPain
tramadol HCl ERPain
TreximetMigraine Headaches
TrulicityDiabetes
Tudorza PressairAsthma/COPD
TykerbOncology
TysarbiMultiple Sclerosis
TyvasoPulmonary Hypertension
UloricInflammatory Conditions
Utibron NeohalerAsthma/COPD
valacyclovir HCLAnti-infective
VarubiNausea/Vomiting
venlafaxine HCLDepression
Ventolin HFAAsthma/COPD
VfendAntifungal
Vibryd Titration PackDepression
VictozaDiabetes
Viekira PakHepatitis C
ViibrydDepression
VivlodexPain
VotrientOncology
VraylarMental/Neurological Disorders
VytorinHigh Blood Cholesterol
XalkoriOncology
XenazineMental/Neurological Disorders
XermeloOncology
XgevaOncology
XifaxanAnti-infective
Xigduo XRDiabetes
XolairAsthma Specialty
XtandiOncology
XultophyDiabetes
YervoyOncology
zaleplonSleep Disorder
ZecuityMigraine Headaches
ZejulaOncology
ZelborafOncology
ZembraceMigraine Headaches
ZepatierHepatitis C
ziprasidone HCLMental/Neurological Disorders
Zohydro ERPain - Narcotic
ZolinzaOncology
zolmitriptanMigraine Headaches
zolpidem tartrateSleep Disorder
ZolpimistSleep Disorder
ZorvolexPain
ZubsolvPain - Narcotic
ZuplenzNausea/Vomiting
ZydeligOncology
ZykadiaOncology
ZytigaOncology