2016 -- H 8022

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LC005609

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Blazejewski, O'Brien, McKiernan, Solomon, and

     Date Introduced: March 31, 2016

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-50.1. Medication synchronization. – (a) An individual or group health insurance

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policy providing prescription drug coverage in the state must permit and apply a prorated daily

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cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty

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(30) days' supply if the prescriber or pharmacist determines the fill or refill to be in the best

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interest of the patient and the patient requests or agrees to less than a thirty (30) days' supply for

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the purpose of synchronizing the patient's medications.

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     No individual or group health insurance policy providing prescription drug coverage shall

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deny coverage for the dispensing of a chronic medication that is made in accordance with a plan

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among the health plan, individual beneficiary or group plan, a practitioner and a pharmacist for

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the purpose of synchronizing the filling or refilling of multiple prescriptions for the insured. The

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individual or group health plan must allow a pharmacy to override any denial codes indicating

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that a prescription is being refilled too soon for the purposes of medication synchronization.

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     No individual or group health insurance policy providing prescription drug coverage shall

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use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled

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or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any

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pro­ rated copay for the beneficiary or fee paid for alignment services.

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     (b) A pharmacist may exercise their professional judgment in refilling a prescription for a

 

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quantity of a drug greater than the initial quantity of a drug prescribed by the prescribing

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practitioner, provided:

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     (1) Such refill is made after the patient's initial prescription is dispensed;

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     (2) Such refill does not exceed a ninety (90) days' supply of such drug and does not

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exceed the total quantity of such drug authorized by the prescribing practitioner;

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     (3) The prescribing practitioner has not indicated that the initial quantity or refill quantity

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of the prescribed drug shall not be changed;

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     (4) Such drug is not a controlled drug, as listed in §21-28-2.08;

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     (5) The pharmacist informs the prescribing practitioner of such refill at the earliest

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reasonable time, but not later than forty-eight (48) hours after such refill is made; and

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     (6) The patient's health insurance policy or health benefit plan, if any, will cover the refill

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quantity dispensed, without additional coinsurance, deductible or other out-of­pocket expense

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required from the patient.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would authorize pharmacies to dispense prescriptions of less than a thirty (30)

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day supply for the purpose of synchronizing a patient's medications. Additionally, the act would

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permit pharmacists to dispense a ninety (90) day supply upon refilling a patient's original

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prescription under certain circumstances.

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     This act would take effect upon passage.

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LC005609

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