HOUSE DOCKET, NO. 122        FILED ON: 1/13/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1191

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Daniel J. Ryan

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to help patients and reduce health care costs by ensuring patient adherence to medications.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Daniel J. Ryan

2nd Suffolk

1/13/2021


HOUSE DOCKET, NO. 122        FILED ON: 1/13/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 1191

By Mr. Ryan of Boston, a petition (accompanied by bill, House, No. 1191) of Daniel J. Ryan relative to further regulating individual or group health insurance policies providing prescription drug coverage.  Financial Services.

 

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1099 OF 2019-2020.]

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninety-Second General Court
(2021-2022)

_______________

 

An Act to help patients and reduce health care costs by ensuring patient adherence to medications.

 

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. An individual or group health insurance policy providing prescription drug coverage in the state must permit and apply a pro-rated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient’s medications.

No individual or group health insurance policy providing prescription drug coverage shall deny coverage for the dispensing of a medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient’s medications. The individual or group health plan must allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization. 

No individual or group health insurance policy providing prescription drug coverage shall use payment structures incorporating pro-rated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any pro-rated copay for the beneficiary or fee paid for alignment services.