§ 3761-515.1. Medication synchronization
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 72 P.S. Taxation and Fiscal AffairsEffective: October 23, 2018
Effective: October 23, 2018
72 P.S. § 3761-515.1
§ 3761-515.1. Medication synchronization
(a) Prorated daily cost-sharing fees.--The program shall permit and apply a prorated daily cost-sharing fee to prescription drugs that are dispensed by a pharmacy for less than a 30 days' supply if the pharmacist or prescriber determines the fill or refill to be in the best interest of the program participant and the program participant requests or agrees to less than a 30 days' supply for the purpose of medication synchronization. The program may not use payment structures incorporating prorated dispensing fees.
(c) Partial supply.--The program may not deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescriber or pharmacist determines the fill or refill is in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of medication synchronization.
(e) Override of denial codes.--Subject to section 520(c.1),1 the program shall allow a pharmacy to override any denial codes indicating that a prescription drug is being refilled too soon for the purposes of medication synchronization utilizing the submission clarification and message codes as adopted by the National Council for Prescription Drug Programs or alternative codes provided by the program.
(2) controlled substances classified in Schedule II under section 4(2) of the act of April 14, 1972 (P.L. 233, No. 64),2 known as The Controlled Substance, Drug, Device and Cosmetic Act.
Credits
1971, Aug. 26, P.L. 351, No. 91, § 515.1, added 2018, Oct. 23, P.L. 579, No. 87, § 2, imd. effective.
72 P.S. § 3761-515.1, PA ST 72 P.S. § 3761-515.1
Current through Act 13 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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