| Ten (10) grams every month, regardless of drug dispensed | |
| Bactroban Nasal 2% Ointment | |
| Thirty (30) grams every month, regardless of drug dispensed | |
| Altabax 1% Ointment | |
| Sixty (60) grams every month, regardless of drug dispensed | |
| Bactroban 2% Cream | |
| Sixty-six (66) grams every month, regardless of drug dispensed | |
| mupirocin 2% Ointment | |
| Eight (8) syringes (four boxes) every month, regardless of the drug dispensed | |
| Imitrex 4mg/0.5 ml Kit Refill | |
| Imitrex 4mg/0.5 ml Syring Refill | |
| Imitrex 6mg/0.5 ml Kit Refill | |
| Imitrex 6mg/0.5ml Syring Kit | |
| Imitrex 6mg/0.5ml Vial | |
| Six (6) nasal sprays (one box) every month, regardless of the drug dispensed | |
| Imitrex 5mg Nasal Spray | |
| Imitrex 20mg Nasal Spray | |
| Zomig 5mg Nasal Spray | |
| Eighteen (18) tablets every month, regardless of the drug dispensed | |
| Amerge 1mg Tablet | |
| Amerge 2.5mg Tablet | |
| Axert 6.25mg Tablet | |
| Axert 12.5mg Tablet | |
| Frova 2.5mg Tablet | |
| Imitrex 25mg Tablet | |
| Imitrex 50mg Tablet | |
| Imitrex 100mg Tablet | |
| Maxalt 5MG Tablet | |
| Maxalt 10mg Tablet | |
| Maxalt MLT 5mg Tablet | |
| Maxalt MLT 10mg Tablet | |
| Relpax 20mg Tablet | |
| Relpax 40mg Tablet | |
|
N |
Treximet 85-50mg Tablet |
| Zomig 2.5mg Tablet | |
| Zomig 5mg Tablet | |
| Zomig ZMT 2.5mg Tablet | |
| Zomig ZMT 5mg Tablet | |
| One (1) each every 100 Days, regardless of drug dispensed | |
| Medroxyprogesterone Acetate | |
| Three (3) each every 100 Days, regardless of drug dispensed | |
| Nuvaring | |
| Nine (9) each every 100 Days, regardless of drug dispensed | |
| Ortho Evra Patch | |
| Thirty-four (34) tablets every month, regardless of drug dispensed | |
| Januvia 25mg Tablet | |
| Januvia 50mg Tablet | |
| Januvia 100 mg Tablet | |
| Sixty-eight (68) tablets every month, regardless of drug dispensed | |
| Janumet 50/ 500 mg Tablet | |
| Janumet 50/1,000mg Tablet | |
| Eight-four (84) tablets every month, regardless of drug dispensed | |
| Soma 250 mg Tablets | |
N=New Product with Quantity Limits; D=Product Deleted from Quantity Limits Restrictions
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