§2769. Prescription synchronization
1. Synchronization. If a health plan provides coverage for prescription drugs, a carrier:
A. Shall permit and apply a prorated daily cost-sharing rate to a prescription that is dispensed by a pharmacist in the carrier's network for less than a 30-day supply if the prescriber or pharmacist determines that filling or refilling the prescription for less than a 30-day supply is in the best interest of the patient and the patient requests or agrees to less than a 30-day supply in order to synchronize the refilling of that prescription with the patient's other prescriptions; [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
B. May not deny coverage for the dispensing of a medication prescribed for the treatment of a chronic illness that is made in accordance with a plan developed by the carrier, the insured, the prescriber and a pharmacist to synchronize the filling or refilling of multiple prescriptions for the insured. The carrier shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon in order to synchronize the patient's prescriptions; and [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
C. May not use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions must be paid in full for each prescription dispensed, regardless of any prorated copay for the insured or fee paid for alignment services. [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
[PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
2. Application; exclusion. The requirements of this section do not apply to a prescription for:
A. Solid oral doses of antibiotics; or [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
B. Solid oral doses that are dispensed in their original container as indicated in the federal Food and Drug Administration Prescribing Information or are customarily dispensed in their original packaging to assist a patient with compliance. [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
[PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]
SECTION HISTORY
PL 2015, c. 93, §1 (NEW). PL 2015, c. 93, §2 (AFF).
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