1. (1) As used in this section:

   1. (a) “Health plan” means:

      1. (A) A “health benefit plan” as defined in ORS 743B.005; and
      2. (B) A self-insured health plan offered by the Oregon Health and Science University.
   2. (b) “Synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.
2. (2) A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan’s enrollees.
3. (3) A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan’s synchronization policy.

4. (4) If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills, a health plan shall:

   1. (a) Prorate the copayment; or
   2. (b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.
5. (5) A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.

6. (6) This section does not apply to prescription drugs that:

   1. (a) Are in unit-of-use packaging for which synchronization is not possible;
   2. (b) Are controlled substances; or
   3. (c) Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.
7. (7) The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.

8. (8)

   1. (a) This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.
   2. (b) As used in this subsection, “prepaid group practice health plan” means a health care service contractor that provides physician services to its enrollees through an integrated health care delivery system using, primarily, a single group of physicians contracted on a prepaid, capitated basis.

Note: 743B.601 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

[2014 c.25 §2; 2015 c.800 §1; 2017 c.309 §6]