26:2J-4.38 Health maintenance organization, coverage for synchronization of prescribed medications.
6. a. Every certificate of authority to establish and operate a health maintenance organization in this State issued, continued or renewed in this State, or approved for issuance, continuation or renewal in this State on or after the effective date of this act, which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall, on at least one occasion per year for each covered person:
(1)apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a 30 days' supply if the prescriber or pharmacist indicates the fill or refill is in the best interest of the covered person or is for the purpose of synchronizing the covered person's chronic medications;
(2) provide coverage for a drug prescribed for the treatment of a chronic illness dispensed in accordance with a plan among the covered person, the prescriber and the pharmacist to synchronize the refilling of multiple prescriptions for the covered person; and
(3)determine dispensing fees based exclusively on the total number of prescriptions dispensed; dispensing fees shall not be prorated or based on the number of the days' supply of medication prescribed or dispensed.
b.This section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
c.This section shall not apply to prescriptions for opioid analgesics. "Opioid analgesic" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release form, and whether or not combined with other drug substances to form a single drug product or dosage form.
L.2015, c.206, s.6.
Section: Previous 26-2j-4.31 26-2j-4.32 26-2j-4.33 26-2j-4.34 26-2j-4.35 26-2j-4.36 26-2j-4.37 26-2j-4.38 26-2j-5 26-2j-6 26-2j-7 26-2j-8 26-2j-8.1 26-2j-9 26-2j-10 Next
Last modified: October 11, 2016