(a) As used in this Section, “synchronization” means the coordination of medication refills for a patient taking 2 or more medications for one or more chronic conditions such that the patient’s medications are refilled on the same schedule for a given time period.
     (b) Every policy of health and accident insurance amended, delivered, issued, or renewed after August 18, 2017 (the effective date of Public Act 100-138) that provides coverage for prescription drugs shall provide for synchronization of prescription drug refills on at least one occasion per insured per year, provided all of the following conditions are met:

Terms Used In Illinois Compiled Statutes 215 ILCS 5/356z.26

  • Contract: A legal written agreement that becomes binding when signed.
  • insured: as used in this article , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. See Illinois Compiled Statutes 215 ILCS 5/357.28

         (1) the prescription drugs are covered by the
    
policy’s clinical coverage policy or have been approved by a formulary exceptions process;
        (2) the prescription drugs are maintenance
    
medications as defined by the policy and have available refill quantities at the time of synchronization;
        (3) the medications are not Schedule II, III, or IV
    
controlled substances;
        (4) the insured meets all utilization management
    
criteria specific to the prescription drugs at the time of synchronization;
        (5) the prescription drugs are of a formulation that
    
can be safely split into short-fill periods to achieve synchronization; and
        (6) the prescription drugs do not have special
    
handling or sourcing needs as determined by the policy, contract, or agreement that require a single, designated pharmacy to fill or refill the prescription.
    (c) When necessary to permit synchronization, the policy shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this Section. No dispensing fees shall be prorated, and all dispensing fees shall be based on the number of prescriptions filled or refilled.
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