- (a) This section does not apply to a mail order pharmacy or to specialty drugs.
- (b) This section applies to an individual contract or a group contract that provides coverage for prescription medications.
(c) As used in this section, "synchronize" means to use a single pharmacy dispensing process as a means of coordinating the enrollee's medications at the same time when:
(1) a particular medication:
- (A) is of a formulation that can be effectively split; and
- (B) does not have quantity limits or dose optimization criteria as specified in the individual or group contract's formulary and prior authorization requirements;
- (2) the enrollee is on a stabilized treatment plan for a chronic condition and the synchronization is for those drugs treating a chronic condition; and
(3) the medication is not:
- (A) an opioid, stimulant, sedative, or hypnotic medication; or
- (B) another medication that is addictive and subject to abuse.
- (d) An individual contract or group contract that provides coverage for prescription drugs may not deny coverage for the refill of any drug prescribed for the treatment of a chronic illness that is made in accordance with a plan between the enrollee and a pharmacist to synchronize the refilling of multiple prescriptions for the enrollee.
- (e) An individual contract or a group contract must provide coverage for a medication that is dispensed in a quantity that allows synchronization of the enrollee's medications in accordance with a plan made between the enrollee and the pharmacy to synchronize the enrollee's medications for chronic conditions.
As added by P.L.202-2017, SEC.21.