2016 -- H 8022 SUBSTITUTE A

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LC005609/SUB A

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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:

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

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

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

plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017

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

sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network

pharmacy for less than a thirty (30) days' supply if the prescriber and pharmacist determines the

fill or refill to be in the best interest of the patient for the management or treatment of a chronic

long-term care condition and the patient requests or agrees to less than a thirty (30) days' supply

for the purpose of synchronizing the patient's medications and the insured's or enrollee's

maintenance prescription drug(s) to be synchronized meets all of the following requirements:

     (1) Is covered by the policy, certificate, or contract described in this chapter;

     (2) Is used for the management and treatment of a chronic long-term care condition and

have authorized refills that remain available to the insured or enrollee;

     (3) Except as otherwise provided in this subparagraph, is not a controlled substance

included in schedules 2 to 5;

     (4) Meets all utilization management requirements specific to the maintenance

prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple

maintenance prescription drugs;

     (5) Is of a formulation that can be effectively split over required short fill periods to

achieve synchronization; and

     (6) Does not have quantity limits or dose optimization criteria or requirements that will

be violated when synchronizing the insured's or enrollee's multiple maintenance prescription

drugs.

     (b) The plan or policy described in subsection (a) shall apply a prorated daily cost sharing

rate for maintenance prescription drugs that are dispensed by an in-network pharmacy for the

purpose of synchronizing the insured's or enrollee's multiple maintenance prescription drugs.

     (c) The plan or policy described in subsection (a) shall not reimburse or pay any

dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is

based on each maintenance prescription drug dispensed.

     (d) A synchronization shall only occur once per year per maintenance prescription drug.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-26.1.Medication synchronization. – (a) An individual or group health insurance

plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017

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

sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network

pharmacy for less than a thirty (30) days' supply if the prescriber and pharmacist determines the

fill or refill to be in the best interest of the patient for the management or treatment of a chronic

long-term care condition and the patient requests or agrees to less than a thirty (30) days' supply

for the purpose of synchronizing the patient's medications and the insured's or enrollee's

maintenance prescription drug(s) to be synchronized meets all of the following requirements:

     (1) Is covered by the policy, certificate, or contract described in this chapter;

     (2) Is used for the management and treatment of a chronic long-term care condition and

have authorized refills that remain available to the insured or enrollee;

     (3) Except as otherwise provided in this subparagraph, is not a controlled substance

included in schedules 2 to 5;

     (4) Meets all utilization management requirements specific to the maintenance

prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple

maintenance prescription drugs;

     (5) Is of a formulation that can be effectively split over required short fill periods to

achieve synchronization; and

     (6) Does not have quantity limits or dose optimization criteria or requirements that will

LC005609/SUB A - Page 2 of 6

be violated when synchronizing the insured's or enrollee's multiple maintenance prescription

drugs.

     (b) The plan or policy described in subsection (a) shall apply a prorated daily cost sharing

rate for maintenance prescription drugs that are dispensed by an in-network pharmacy for the

purpose of synchronizing the insured's or enrollee's multiple maintenance prescription drugs.

     (c) The plan or policy described in subsection (a) shall not reimburse or pay any

dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is

based on each maintenance prescription drug dispensed.

     (d) A synchronization shall only occur once per year per maintenance prescription drug.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-23.1. Medication synchronization. -- (a) An individual or group health insurance

plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017

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

sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network

pharmacy for less than a thirty (30) days' supply if the prescriber and pharmacist determines the

fill or refill to be in the best interest of the patient for the management or treatment of a chronic

long-term care condition and the patient requests or agrees to less than a thirty (30) days' supply

for the purpose of synchronizing the patient's medications and the insured's or enrollee's

maintenance prescription drug(s) to be synchronized meets all of the following requirements:

     (1) Is covered by the policy, certificate, or contract described in this chapter;

     (2) Is used for the management and treatment of a chronic long-term care condition and

have authorized refills that remain available to the insured or enrollee;

     (3) Except as otherwise provided in this subparagraph, is not a controlled substance

included in schedules 2 to 5;

     (4) Meets all utilization management requirements specific to the maintenance

prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple

maintenance prescription drugs;

     (5) Is of a formulation that can be effectively split over required short fill periods to

achieve synchronization; and

     (6) Does not have quantity limits or dose optimization criteria or requirements that will

be violated when synchronizing the insured's or enrollee's multiple maintenance prescription

drugs.

     (b) The plan or policy described in subsection (a) shall apply a prorated daily cost sharing

LC005609/SUB A - Page 3 of 6

rate for maintenance prescription drugs that are dispensed by an in-network pharmacy for the

purpose of synchronizing the insured's or enrollee's multiple maintenance prescription drugs.

     (c) The plan or policy described in subsection (a) shall not reimburse or pay any

dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is

based on each maintenance prescription drug dispensed.

     (d) A synchronization shall only occur once per year per maintenance prescription drug.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-38.1. Medication synchronization. -- (a) An individual or group health insurance

plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017

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

sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network

pharmacy for less than a thirty (30) days' supply if the prescriber and pharmacist determines the

fill or refill to be in the best interest of the patient for the management or treatment of a chronic

long-term care condition and the patient requests or agrees to less than a thirty (30) days' supply

for the purpose of synchronizing the patient's medications and the insured's or enrollee's

maintenance prescription drug(s) to be synchronized meets all of the following requirements:

     (1) Is covered by the policy, certificate, or contract described in this chapter;

     (2) Is used for the management and treatment of a chronic long-term care condition and

have authorized refills that remain available to the insured or enrollee;

     (3) Except as otherwise provided in this subparagraph, is not a controlled substance

included in schedules 2 to 5;

     (4) Meets all utilization management requirements specific to the maintenance

prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple

maintenance prescription drugs;

     (5) Is of a formulation that can be effectively split over required short fill periods to

achieve synchronization; and

     (6) Does not have quantity limits or dose optimization criteria or requirements that will

be violated when synchronizing the insured's or enrollee's multiple maintenance prescription

drugs.

     (b) The plan or policy described in subsection (a) shall apply a prorated daily cost sharing

rate for maintenance prescription drugs that are dispensed by an in-network pharmacy for the

purpose of synchronizing the insured's or enrollee's multiple maintenance prescription drugs.

     (c) The plan or policy described in subsection (a) shall not reimburse or pay any

LC005609/SUB A - Page 4 of 6

dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is

based on each maintenance prescription drug dispensed.

     (d) A synchronization shall only occur once per year per maintenance prescription drug.

     SECTION 5. This act shall take effect on January 1, 2017.

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LC005609/SUB A

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would direct health insurers to provide prescription drug coverage for

prescriptions of less than a thirty (30) day supply for the treatment of chronic conditions. The

purpose would be to synchronize a patient's medications.

     This act would take effect upon passage.

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LC005609/SUB A

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