(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days’ supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days’ supply for the purpose of synchronizing the patient’s medications and the insured‘s or enrollee’s maintenance prescription drug(s) to be synchronized meets all of the following requirements:
Terms Used In Rhode Island General Laws 27-18-50.1
- insured: as used in this chapter , 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 the policy to any indemnities, benefits, and rights provided in the policy. See Rhode Island General Laws 27-18-7.
(1) Is covered by the policy, certificate, or contract described in this chapter;
(2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;
(3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;
(4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured’s or enrollee’s multiple, maintenance-prescription drugs;
(5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and
(6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
(b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
(c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.
(d) A synchronization shall only occur once per year per maintenance-prescription drug.
(P.L. 2016, ch. 179, § 1; P.L. 2016, ch. 196, § 1.)