KRS 304.17A-165: Prescription drug coverage to include exceptions or override policy

for refills of covered drugs -- Limitations and exclusions -- Program for

synchronization of medications.

(1) Any health benefit plan that provides benefits for prescription drugs shall include an

exceptions policy or an override policy that provides coverage for the refill of a

covered drug dispensed prior to the expiration of the insured's supply of the drug.

The insurer shall provide notice in existing written or elec tronic communications to

pharmacies doing business with the insurer, the pharmacy benefit manager if

applicable, and to the insured regarding the exceptions policy or override policy.

This subsection shall not apply to controlled substances as classified b y KRS

Chapter 218A.

(2) Nothing in this section shall prohibit an insurer from limiting payment to no more

than three (3) refills of a covered drug in a ninety (90) day period.

(3) Any individual or group health benefit plan that provides benefits for pres cription

drugs shall provide a program for synchronization of medications when it is agreed

among the insured, 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 individual or group health benefit plan:

(b) Are used for treatment and management of chronic conditions that are subject

to refills;

(c) Are not a Schedule II controlled substance;

(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.

(4) To permit synchronization, an individual or group health benefit plan shall apply a

prorated daily c ost-sharing rate to any medication dispensed by a network

pharmacy pursuant to this section.

(5) Any dispensing fee shall not be prorated and shall be based on an individual

prescription filled or refilled.