205.529 Synchronization of multiple prescriptions for treatment of a chronic

243 words·~1 min read·/ky/205-529

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

illness.

(1)The Department for Medicaid Services or a managed care organization contracted

to provide services pursuant to this chapter shall provide a program for

synchronization of medications when it is agreed among the member, a provider,

and a pharmacist that synchronization of multiple prescriptions for the treatment of

a chronic illness is in the best interest of the patient for the management or

treatment of a chronic illness provided that the medications:

(a)Are covered by the Department for Medicaid Services or a managed care

organization contracted to provide services pursuant to this chapter;

(b)Are used for treatment and management of chronic conditions that are subject

to refills;

(c)Are not a Schedule II controlled substance or a Schedule III controlled

substance containing hydrocodone;

(d)Meet all prior authorization criteria specific to the medications at the time of

the synchronization request;

(e)Are of a formulation that can be effectively split over required short fill

periods to achieve synchronization; and

(f)Do not have quantity limits or dose optimization criteria or requirements that

would be violated in fulfilling synchronization.

(2)When applicable to permit synchronization, the Department for Medicaid Services

or a managed care organization contracted to provide services pursuant to this

chapter shall apply a prorated daily cost-sharing rate to any medication dispensed by

a network pharmacy pursuant to this section.

(3)Any dispensing fee shall not be prorated and shall be based on an individual

prescription filled or refilled.