§36-3634.5. Synchronization of prescription drug refills.
283 words·~1 min read·
/ok/title-36-insurance/36-3634-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. A health benefit plan that provides benefits for prescription drugs delivered, issued or renewed after November 1, 2017, shall provide for synchronization of prescription drug refills on at least one occasion per insured per year, provided all of the following conditions are met:
1. The prescription drugs are covered by the health benefit plan's clinical coverage policy or have been approved by a formulary exceptions process;
2. The prescription drugs are maintenance medications as defined by the plan and have available refill quantities at the time of synchronization;
3. The medications are not Schedule II, III or IV controlled substances;
4. The insured meets all utilization management criteria to the prescription drugs at the time of synchronization;
5. The prescription drugs are of a formulation that can be safely split into short-fill periods to achieve synchronization;
6. The prescription drugs do not have special handling or sourcing needs as determined by the plan, contract, or agreement that require a single, designated pharmacy to fill or refill the prescription; and
7. The covered person agrees to the synchronization.
B. When necessary to permit synchronization, the health benefit plan shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this section. No dispensing fees shall be prorated, and all dispensing fees shall be based on the number of prescriptions filled or refilled.
C. As used in this section, "synchronization" means the coordination of medication refills for a patient taking two or more medications for one or more chronic conditions such that the patient's medications are refilled on the same schedule for a given time period. Added by Laws 2017, c. 140, § 1, eff. Nov. 1, 2017.