2018 -- S 2229

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LC004139

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Senators Pearson, Goldin, Paolino, Miller, and Picard

     Date Introduced: February 01, 2018

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-50.1 of the General Laws in Chapter 27-18 entitled

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"Accident and Sickness Insurance Policies" is hereby amended to read as follows:

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     27-18-50.1. Medication synchronization. [Effective January 1, 2017.]

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     (a) An individual or group health insurance plan or policy delivered, issued for delivery,

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or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the

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state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a

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chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days'

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supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the

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patient for the management or treatment of a chronic, long-term care condition and the patient

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requests or agrees to less than a thirty (30) days' supply for the purpose of synchronizing the

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patient's medications and the insured's or enrollee's maintenance prescription drug(s) to be

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synchronized meets all of the following requirements:

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

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

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

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

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included in schedules II to V;

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

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

 

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maintenance-prescription drugs;

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

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achieve synchronization; and

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

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

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drugs.

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

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

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

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

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

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based on each maintenance-prescription drug dispensed.

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

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     (a) An individual or group health insurance policy providing prescription drug coverage

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in the state must permit and apply a prorated daily cost-sharing rate to prescriptions that are

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dispensed by a network pharmacy for a partial supply if the prescriber or pharmacist determines

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the fill or refill to be in the best interest of the patient and the patient requests or agrees to a

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partial supply for the purpose of synchronizing the patient's medications.

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     (b) No individual or group health insurance policy providing prescription drug coverage

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shall deny coverage for the dispensing of a medication that is dispensed by a network pharmacy

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on the basis that the dispensing is for a partial supply if the prescriber or pharmacist determines

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the fill or refill to be in the best interest of the patient and the patient requests or agrees to a

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partial supply for the purpose of synchronizing the patient's medications. The individual or group

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health plan must allow a pharmacy to override any denial codes indicating that a prescription is

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being refilled too soon for the purposes of medication synchronization.

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     (c) No individual or group health insurance policy providing prescription drug coverage

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

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

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any prorated copay for the beneficiary or fee paid for alignment services.

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     SECTION 2. This act shall take effect upon passage.

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LC004139

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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.

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     This act would take effect upon passage.

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LC004139

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