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

____________

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:

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

included in schedules 2 to 5;

17

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

18

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

19

maintenance prescription drugs;

 

1

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

2

achieve synchronization; and

3

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

4

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

5

drugs.

6

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

7

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

8

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

9

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

10

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

11

based on each maintenance prescription drug dispensed.

12

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

13

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

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

included in schedules 2 to 5;

29

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

30

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

31

maintenance prescription drugs;

32

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

33

achieve synchronization; and

34

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

 

LC005609/SUB A - Page 2 of 6

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

2

drugs.

3

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

4

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

5

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

6

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

7

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

8

based on each maintenance prescription drug dispensed.

9

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

10

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

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

included in schedules 2 to 5;

26

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

27

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

28

maintenance prescription drugs;

29

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

30

achieve synchronization; and

31

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

32

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

33

drugs.

34

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

 

LC005609/SUB A - Page 3 of 6

1

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

2

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

3

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

4

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

5

based on each maintenance prescription drug dispensed.

6

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

7

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

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

included in schedules 2 to 5;

23

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

24

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

25

maintenance prescription drugs;

26

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

27

achieve synchronization; and

28

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

29

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

30

drugs.

31

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

32

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

33

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

34

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

 

LC005609/SUB A - Page 4 of 6

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

2

based on each maintenance prescription drug dispensed.

3

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

4

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

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LC005609/SUB A

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LC005609/SUB A - Page 5 of 6

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

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

2

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

3

purpose would be to synchronize a patient's medications.

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     This act would take effect upon passage.

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LC005609/SUB A

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LC005609/SUB A - Page 6 of 6