Budget Amendment ID: FY2018-S3-518

EHS 518

Medication Synchronization

Ms. L'Italien moved that the proposed new text be amended by inserting the following new section:

"SECTION X. 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."