20-848. Prescriptions; cost sharing; refills; dispensing fees; definition
A. A subscription contract that is issued or renewed on or after January 1, 2017 and that provides coverage for prescription drugs:
1. May not deny coverage and shall prorate the cost sharing rate for a prescription drug covered by the contract that is dispensed by a network pharmacy for less than the standard refill amount if the subscriber requests enrollment into a medication synchronization program and less than the standard refill amount for the purpose of synchronizing the subscriber's medications.
2. Shall accept early refill and short fill requests for prescription drugs using the submission clarification and message codes as adopted by the national council for prescription drug plans or alternative codes provided by the plan upon July 3, 2015.
B. For the purposes of this section, " medication synchronization" means the coordination of medication refills for a patient taking two or more medications for a chronic condition that are being dispensed by a single contracted pharmacy to facilitate the synchronization of the patient's medications for the purpose of improving medication adherence.
Section: Previous 20-841.10 20-842 20-843 20-844 20-845 20-846 20-847 20-848 20-861 20-862 20-863 20-864 20-865 20-866 20-867 NextLast modified: October 13, 2016