2023 Ohio Revised Code › Title 17 | Corporations-Partnerships › Chapter 1751 | Health Insuring Corporation Law › Section 1751.68 | Provisions for Medication Synchronization for Enrollees.

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 enrollee under an individual or group health insuring corporation policy, contract, or agreement according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the policy, contract, or agreement.
(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 health insuring corporation policy, contract, or agreement that provides prescription drug coverage shall provide for medication synchronization for an enrollee if all of the following conditions are met:
(1) The enrollee elects to participate in medication synchronization;
(2) The enrollee, the prescriber, and a pharmacist at a network pharmacy agree that medication synchronization is in the best interest of the enrollee;
(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 enrollee, a prescription drug must meet all of the following requirements:
(1) Be covered by the policy, contract, or agreement;
(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, contract, or agreement, 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, contract, or agreement 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 enrollee, 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, contract, or agreement 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, contract, or agreement to waive any cost-sharing requirement in its entirety.
(F) A policy, contract, or agreement 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 health insuring corporation 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 enrollee.