2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3923 | Sickness and Accident Insurance › Section 3923.602 | Medication Synchronization for Insured.

Effective:
March 22, 2020
Latest Legislation:
Senate Bill 229 - 132nd General Assembly
(A) As used in this section:
(1) "Cost-sharing" means the cost to an insured under a policy of sickness and accident insurance or a public employee benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the policy or plan.
(2) "Drug" has the same meaning as in section 4729.01 of the Revised Code.
(3) "Medication synchronization" means a pharmacy service that synchronizes the filling or refilling of prescriptions in a manner that allows the dispensed drugs to be obtained on the same date each month.
(4) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code.
(5) "Prescription" means a written, electronic, or oral order issued by a prescriber for drugs or combinations or mixtures of drugs to be used by a particular individual.
(B) Notwithstanding section 3901.71 of the Revised Code, each policy of sickness and accident insurance that provides prescription drug coverage and each public employee benefit plan that provides prescription drug coverage shall provide for medication synchronization for an insured if all of the following conditions are met:
(1) The insured elects to participate in medication synchronization;
(2) The insured, the prescriber, and a pharmacist at a network pharmacy agree that medication synchronization is in the best interest of the insured;
(3) The prescription drug to be included in the medication synchronization meets the requirements of division (C) of this section.
(C) To be eligible for inclusion in medication synchronization for an insured, a prescription drug must meet all of the following requirements:
(1) Be covered by the policy or plan;
(2) Be prescribed for the treatment and management of a chronic disease or condition and be subject to refills;
(3) Satisfy all relevant prior authorization criteria;
(4) Not have quantity limits, dose optimization criteria, or other requirements that would be violated if synchronized;
(5) Not have special handling or sourcing needs, as determined by the policy or plan, that require a single, designated pharmacy to fill or refill the prescription;
(6) Be formulated so that the quantity or amount dispensed can be effectively divided in order to achieve synchronization;
(7) Not be a schedule II controlled substance, opioid analgesic, or benzodiazepine, as those terms are defined in section 3719.01 of the Revised Code.
(D)(1) To provide for medication synchronization under division (B) of this section, a policy or plan shall authorize coverage of a prescription drug subject to medication synchronization when the drug is dispensed in a quantity or amount that is less than a thirty-day supply.
(2) The requirement of division (D)(1) of this section applies only once for each prescription drug subject to medication synchronization for the same insured, except when either of the following occurs:
(a) The prescriber changes the dosage or frequency of administration of the prescription drug subject to medication synchronization.
(b) The prescriber prescribes a different drug.
(E)(1) A policy or plan that provides for medication synchronization under division (B) of this section shall permit and apply a prorated daily cost-sharing rate for a supply of a prescription drug subject to medication synchronization that is dispensed at a network pharmacy.
(2) Division (E)(1) of this section does not require a policy or plan to waive any cost-sharing requirements in its entirety.
(F) A policy or plan that provides for medication synchronization under division (B) of this section shall not use payment structures that incorporate dispensing fees that are determined by calculating the days' supply of drugs dispensed. Dispensing fees shall be based exclusively on the total number of prescriptions that are filled or refilled.
(G) This section does not require a sickness and accident insurer or public employee benefit plan to provide to a network pharmacy or a pharmacist at a network pharmacy any monetary or other financial incentive for the purpose of encouraging the pharmacy or pharmacist to recommend medication synchronization to an insured.