N.Y. Insurance Law § 3224-d: Prescription synchronization

§ 3224-d. Prescription synchronization. (a) Every individual or group

health insurance policy providing prescription drug coverage when

applicable to permit synchronization shall permit and apply a daily

pro-rated cost-sharing rate to prescriptions that are dispensed by a

network pharmacy for less than a thirty day supply, when it is agreed

among the covered individual, a health care practitioner, and a

pharmacist that synchronization of multiple prescriptions for the

treatment of a chronic illness is in the best interest of the covered

individual for the management or treatment of that chronic illness

provided that all of the following apply:

(i) The medications are covered by the policy or plan.

(ii) The medications are used for treatment and management of chronic

conditions that are subject to refills.

(iii) The medications are not a Schedule II controlled substance or a

Schedule III controlled substance containing hydrocodone.

(iv) The medications meet all prior authorization criteria specific to

medications at the time of the synchronization request.

(v) The medications are of a formulation that can be effectively split

over required short fill periods to achieve synchronization.

(vi) The medications do not have quantity limits or dose optimization

criteria or requirements that would be violated in fulfilling

synchronization.

(b) No individual or group health insurance policy providing

prescription drug coverage shall deny coverage for the dispensing of a

medication for partial fill when it is for purposes of synchronizing the

patient's medications. When applicable to permit synchronization, every

individual or group health insurance policy must allow a pharmacy to

override any denial codes indicating that a prescription is being

refilled too soon for the purposes of medication synchronization.

(c) Dispensing fees for partially filled or refilled prescriptions

shall be paid in full for each prescription dispensed, regardless of any

pro-rated copay for the beneficiary or fee paid for alignment services.

(d) Nothing in this section shall be deemed to require health care

practitioners and pharmacists to synchronize the refilling of multiple

prescriptions for a covered individual.

(e) The requirements of this paragraph shall apply only once for each

prescription drug subject to medication synchronization except when

either of the following occurs:

(i) The prescriber changes the dosage or frequency of administration

of the prescription drug subject to a medication synchronization; or

(ii) The prescriber prescribes a different drug.