§ 3224-d. Prescription synchronization.
(a)Every individual or group\nhealth insurance policy providing prescription drug coverage when\napplicable to permit synchronization shall permit and apply a daily\npro-rated cost-sharing rate to prescriptions that are dispensed by a\nnetwork pharmacy for less than a thirty day supply, when it is agreed\namong the covered individual, a health care practitioner, and a\npharmacist that synchronization of multiple prescriptions for the\ntreatment of a chronic illness is in the best interest of the covered\nindividual for the management or treatment of that chronic illness\nprovided that all of the following apply:\n (i) The medications are covered by the policy or plan.\n (ii) The medications are used for treatment and management of chronic\ncondi
Free access — add to your briefcase to read the full text and ask questions with AI
§ 3224-d. Prescription synchronization. (a) Every individual or group\nhealth insurance policy providing prescription drug coverage when\napplicable to permit synchronization shall permit and apply a daily\npro-rated cost-sharing rate to prescriptions that are dispensed by a\nnetwork pharmacy for less than a thirty day supply, when it is agreed\namong the covered individual, a health care practitioner, and a\npharmacist that synchronization of multiple prescriptions for the\ntreatment of a chronic illness is in the best interest of the covered\nindividual for the management or treatment of that chronic illness\nprovided that all of the following apply:\n (i) The medications are covered by the policy or plan.\n (ii) The medications are used for treatment and management of chronic\nconditions that are subject to refills.\n (iii) The medications are not a Schedule II controlled substance or a\nSchedule III controlled substance containing hydrocodone.\n (iv) The medications meet all prior authorization criteria specific to\nmedications at the time of the synchronization request.\n (v) The medications are of a formulation that can be effectively split\nover required short fill periods to achieve synchronization.\n (vi) The medications do not have quantity limits or dose optimization\ncriteria or requirements that would be violated in fulfilling\nsynchronization.\n (b) No individual or group health insurance policy providing\nprescription drug coverage shall deny coverage for the dispensing of a\nmedication for partial fill when it is for purposes of synchronizing the\npatient's medications. When applicable to permit synchronization, every\nindividual or group health insurance policy must allow a pharmacy to\noverride any denial codes indicating that a prescription is being\nrefilled too soon for the purposes of medication synchronization.\n (c) Dispensing fees for partially filled or refilled prescriptions\nshall be paid in full for each prescription dispensed, regardless of any\npro-rated copay for the beneficiary or fee paid for alignment services.\n (d) Nothing in this section shall be deemed to require health care\npractitioners and pharmacists to synchronize the refilling of multiple\nprescriptions for a covered individual.\n (e) The requirements of this paragraph shall apply only once for each\nprescription drug subject to medication synchronization except when\neither of the following occurs:\n (i) The prescriber changes the dosage or frequency of administration\nof the prescription drug subject to a medication synchronization; or\n (ii) The prescriber prescribes a different drug.\n