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The 190th General Court of the Commonwealth of Massachusetts

AN ACT RELATIVE TO PRESCRIPTION EYE DROPS.

      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. Chapter 32A of the General Laws is hereby amended by inserting after section 17N the following section:-
      Section 17O.  Coverage offered by the commission to an active or retired employee of the commonwealth insured through the group insurance commission that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
      SECTION 2.  Chapter 112 of the General Laws is hereby amended by inserting after section 12FF the following section:-
      Section 12GG.  (a) A pharmacist may dispense a 90-day supply for a prescribed topical ophthalmic product when: (i) the practitioner prescribed an initial 30-day prescription for the topical ophthalmic product; (ii) the patient completed the initial 30-day prescription; (iii) the practitioner did not indicate on the original prescription that dispensing the prescription in a specific amount with periodic refills is medically necessary; and (iv) the total quantity of dosage units dispensed, including refills, does not exceed the total quantity of dosage units indicated by the practitioner on the prescription.
      (b)  Subsection (a) shall not apply to initial prescriptions for topical ophthalmic products that are prescribed for a 90-day supply.
      (c)  A pharmacist shall not dispense a prescription refill pursuant to this section in excess of the initial prescribed amount if the practitioner instructs otherwise, either orally or in writing.
      (d)  Within a reasonable time following an increase of supply pursuant to this section, the dispensing pharmacist or the pharmacist’s designee shall notify the prescribing practitioner of the increase.
      (e)  This section shall not apply to topical ophthalmic products that are controlled substances as defined by the Controlled Substances Act, 21 U.S.C. 802, or section 1 of chapter 94C, except those classified as schedule VI prescription drugs. 
      (f)  This section shall not apply to prescriptions dispensed in a hospital licensed pursuant to section 51 of chapter 111. No retail pharmacy, however organized, shall be exempt from this section.
      SECTION 3.  Chapter 175 of the General Laws is hereby amended by inserting after section 47GG the following section:-
      Section 47HH.  A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
      SECTION 4.  Chapter 176A of the General Laws is hereby amended by inserting after section 8II the following section:-
      Section 8JJ.  A contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
      SECTION 5.  Chapter 176B of the General Laws is hereby amended by inserting after section 4II the following section:-
      Section 4JJ.  A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
      SECTION 6.  Chapter 176G of the General Laws is hereby amended by inserting after section 4AA the following section:-
      Section 4BB.  An individual or group health maintenance contract that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.

Approved, January 13, 2017