Kentucky Statutes 205.529 – Synchronization of multiple prescriptions for treatment of a chronic illness
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(1) The Department for Medicaid Services or a managed care organization contracted to provide services pursuant to this chapter shall provide a program for synchronization of medications when it is agreed among the member, a provider, and a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest of the patient for the management or treatment of a chronic illness provided that the medications:
(a) Are covered by the Department for Medicaid Services or a managed care organization contracted to provide services pursuant to this chapter;
(b) Are used for treatment and management of chronic conditions that are subject to refills;
(c) Are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone;
(d) Meet all prior authorization criteria specific to the medications at the time of the synchronization request;
(e) Are of a formulation that can be effectively split over required short fill periods to achieve synchronization; and
(f) Do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
(2) When applicable to permit synchronization, the Department for Medicaid Services or a managed care organization contracted to provide services pursuant to this chapter shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this section.
(3) Any dispensing fee shall not be prorated and shall be based on an individual prescription filled or refilled.
Effective: January 1, 2016
History: Created 2015 Ky. Acts ch. 39, sec. 2, effective January 1, 2016.
(a) Are covered by the Department for Medicaid Services or a managed care organization contracted to provide services pursuant to this chapter;
Terms Used In Kentucky Statutes 205.529
- Pharmacist: means a person authorized to practice pharmacy under the laws of the
Commonwealth. See Kentucky Statutes 205.510 - Treatment: when used in a criminal justice context, means targeted interventions
that focus on criminal risk factors in order to reduce the likelihood of criminal behavior. See Kentucky Statutes 446.010
(b) Are used for treatment and management of chronic conditions that are subject to refills;
(c) Are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone;
(d) Meet all prior authorization criteria specific to the medications at the time of the synchronization request;
(e) Are of a formulation that can be effectively split over required short fill periods to achieve synchronization; and
(f) Do not have quantity limits or dose optimization criteria or requirements that would be violated in fulfilling synchronization.
(2) When applicable to permit synchronization, the Department for Medicaid Services or a managed care organization contracted to provide services pursuant to this chapter shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this section.
(3) Any dispensing fee shall not be prorated and shall be based on an individual prescription filled or refilled.
Effective: January 1, 2016
History: Created 2015 Ky. Acts ch. 39, sec. 2, effective January 1, 2016.