{"data":{"id":"us-ky/krs-304.17a-165","jurisdiction":"us-ky","citation":"KRS 304.17A-165","heading":"Prescription drug coverage to include exceptions or override policy","body":"for refills of covered drugs -- Limitations and exclusions -- Program for\nsynchronization of medications.\n(1) Any health benefit plan that provides benefits for prescription drugs shall include an\nexceptions policy or an override policy that provides coverage for the refill of a\ncovered drug dispensed prior to the expiration of the insured's supply of the drug.\nThe insurer shall provide notice in existing written or elec tronic communications to\npharmacies doing business with the insurer, the pharmacy benefit manager if\napplicable, and to the insured regarding the exceptions policy or override policy.\nThis subsection shall not apply to controlled substances as classified b y KRS\nChapter 218A.\n(2) Nothing in this section shall prohibit an insurer from limiting payment to no more\nthan three (3) refills of a covered drug in a ninety (90) day period.\n(3) Any individual or group health benefit plan that provides benefits for pres cription\ndrugs shall provide a program for synchronization of medications when it is agreed\namong the insured, a provider, and a pharmacist that synchronization of multiple\nprescriptions for the treatment of a chronic illness is in the best interest of the\npatient for the management or treatment of a chronic illness provided that the\nmedications:\n(a) Are covered by the individual or group health benefit plan:\n(b) Are used for treatment and management of chronic conditions that are subject\nto refills;\n(c) Are not a Schedule II controlled substance;\n(d) Meet all prior authorization criteria specific to the medications at the time of\nthe synchronization request;\n(e) Are of a formulation that can be effectively split over required short fill\nperiods to achieve synchronization; and\n(f) Do not have quantity limits or dose optimization criteria or requirements that\nwould be violated in fulfilling synchronization.\n(4) To permit synchronization, an individual or group health benefit plan shall apply a\nprorated daily c ost-sharing rate to any medication dispensed by a network\npharmacy pursuant to this section.\n(5) Any dispensing fee shall not be prorated and shall be based on an individual\nprescription filled or refilled.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57306","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"838792c6e3adff23cd1192c0823513dca6af645f4949d9e8549fd178682fa80e","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-164","next":"us-ky/krs-304.17a-166"},"notice":"GroundRules: Original legal text. Not legal advice."}