§ 4303-a. Prescription synchronization.
(a)Every hospital service\ncorporation and health service corporation providing prescription drug\ncoverage when applicable to permit synchronization shall permit and\napply a daily pro-rated cost-sharing rate to prescriptions that are\ndispensed by a network pharmacy for less than a thirty day supply, when\nit is agreed among the covered individual, a health care practitioner,\nand a pharmacist 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 o
Free access — add to your briefcase to read the full text and ask questions with AI
§ 4303-a. Prescription synchronization. (a) Every hospital service\ncorporation and health service corporation providing prescription drug\ncoverage when applicable to permit synchronization shall permit and\napply a daily pro-rated cost-sharing rate to prescriptions that are\ndispensed by a network pharmacy for less than a thirty day supply, when\nit is agreed among the covered individual, a health care practitioner,\nand a pharmacist 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 hospital service corporation or health service corporation\nproviding prescription drug coverage shall deny coverage for the\ndispensing of a medication for partial fill when it is for purposes of\nsynchronizing the patient's medications. When applicable to permit\nsynchronization, every hospital service corporation or health service\ncorporation providing prescription drug coverage must allow a pharmacy\nto override 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