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This entry was published on 2020-01-10
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Prescription synchronization
Insurance (ISC) CHAPTER 28, ARTICLE 32
§ 3224-d. Prescription synchronization. (a) Every individual or group
health insurance policy providing prescription drug coverage when
applicable to permit synchronization shall permit and apply a daily
pro-rated cost-sharing rate to prescriptions that are dispensed by a
network pharmacy for less than a thirty day supply, when it is agreed
among the covered individual, a health care practitioner, and a
pharmacist that synchronization of multiple prescriptions for the
treatment of a chronic illness is in the best interest of the covered
individual for the management or treatment of that chronic illness
provided that all of the following apply:

(i) The medications are covered by the policy or plan.

(ii) The medications are used for treatment and management of chronic
conditions that are subject to refills.

(iii) The medications are not a Schedule II controlled substance or a
Schedule III controlled substance containing hydrocodone.

(iv) The medications meet all prior authorization criteria specific to
medications at the time of the synchronization request.

(v) The medications are of a formulation that can be effectively split
over required short fill periods to achieve synchronization.

(vi) The medications do not have quantity limits or dose optimization
criteria or requirements that would be violated in fulfilling

(b) No individual or group health insurance policy providing
prescription drug coverage shall deny coverage for the dispensing of a
medication for partial fill when it is for purposes of synchronizing the
patient's medications. When applicable to permit synchronization, every
individual or group health insurance policy must allow a pharmacy to
override any denial codes indicating that a prescription is being
refilled too soon for the purposes of medication synchronization.

(c) 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.

(d) Nothing in this section shall be deemed to require health care
practitioners and pharmacists to synchronize the refilling of multiple
prescriptions for a covered individual.

(e) The requirements of this paragraph shall apply only once for each
prescription drug subject to medication synchronization except when
either of the following occurs:

(i) The prescriber changes the dosage or frequency of administration
of the prescription drug subject to a medication synchronization; or

(ii) The prescriber prescribes a different drug.