(a) "Health plan" means:

(A) A "health benefit plan" as defined in ORS 743B.005; and

(B) A self-insured health plan offered by the Oregon Health and Science University.

(b) "Synchronization policy" means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.

(2) A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan’s enrollees.

(3) A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan’s synchronization policy.

(4) If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills, a health plan shall:

(a) Prorate the copayment; or

(b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.

(5) A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.

(6) This section does not apply to prescription drugs that:

(a) Are in unit-of-use packaging for which synchronization is not possible;

(b) Are controlled substances; or

(c) Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.

(7) The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.

(8)(a) This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.

(b) As used in this subsection, "prepaid group practice health plan" means a health care service contractor that provides physician services to its enrollees through an integrated health care delivery system using, primarily, a single group of physicians contracted on a prepaid, capitated basis. [2014 c.25 §2; 2015 c.800 §1; 2017 c.309 §6]

Note: 743B.601 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.