Arizona Laws 20-1057.16. Prescription eyedrops; refills
A. Beginning January 1, 2018, any evidence of coverage that is issued, delivered or renewed by a health care services organization and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription for eyedrops to treat glaucoma or ocular hypertension if all of the following apply:
Terms Used In Arizona Laws 20-1057.16
- Enrollee: means an individual who has been enrolled in a health care plan. See Arizona Laws 20-1051
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Evidence of coverage: means any certificate, agreement or contract issued to an enrollee and setting out the coverage to which the enrollee is entitled. See Arizona Laws 20-1051
- Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
- Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish health care services in this state. See Arizona Laws 20-1051
1. The enrollee requests the refill:
(a) For a thirty-day supply, at least twenty-three days and less than thirty days from the later of:
(i) The original date that the prescription was distributed to the enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
(b) For a sixty-day supply, at least forty-five days and less than sixty days from the later of:
(i) The original date that the prescription was distributed to the enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
(c) For a ninety-day supply, at least sixty-eight days and less than ninety days from the later of:
(i) The original date that the prescription was distributed to the enrollee.
(ii) The date of the most recent refill that was distributed to the enrollee.
2. The prescription eyedrops to treat glaucoma or ocular hypertension prescribed by the health care provider are a covered benefit under the enrollee’s evidence of coverage.
3. The prescribing health care provider indicates on the original prescription that additional quantities of the prescription eyedrops to treat glaucoma or ocular hypertension are needed.
4. The refill requested by the enrollee does not exceed the number of additional quantities prescribed.
B. To the extent practicable, the requirements of this section are limited in quantity to the remaining dosage initially approved for coverage, except that any limited refilling may not limit or restrict coverage to any previously or subsequently approved prescription eyedrops to treat glaucoma or ocular hypertension and is subject to the terms and conditions of the evidence of coverage that are applicable to this coverage.