{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.9_04.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.9_04.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.9_04.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.9_04.html"}],"law_id":56568,"edition_id":1,"section_id":56568,"structure_id":12994,"section_number":"38.2-3407.9:04","catch_line":"Medication synchronization","history":"2018, c. 561.","full_text":"A\n\nAs used in this section:\n\t\t\t“Carrier,” “health plan,” and “provider contract” have the meanings ascribed thereto in subsection A of § 38.2-3407.15.\n\t\t\t“Enrollee” and “provider” have the meanings ascribed thereto in subsection A of § 38.2-3407.10.\n\t\t\t“Network pharmacy” means a pharmacy that has agreed to provide pharmacy services to enrollees with an expectation of receiving payments, other than coinsurance, copayments, or deductibles, directly or indirectly from the carrier under the terms of a provider contract.B\n\nAny health plan providing prescription drug coverage in the Commonwealth shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications, provided that such a proration for any prescription shall not occur more frequently than annually.C\n\nNo health plan providing prescription drug coverage shall deny coverage for the dispensing of a medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications. The health plan shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of synchronizing the enrollee’s medications.D\n\nNo health plan providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copay or fee paid for synchronization services.E\n\nThis section shall apply with respect to health plans that are entered into, amended, extended, or renewed on or after January 1, 2019.F\n\nPursuant to the authority granted by § 38.2-223, the Commission may promulgate such rules and regulations as it may deem necessary to implement this section.G\n\nThe Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.","order_by":null,"text":{"0":{"id":207039,"text":"As used in this section:\n\t\t\t“Carrier,” “health plan,” and “provider contract” have the meanings ascribed thereto in subsection A of § 38.2-3407.15.\n\t\t\t“Enrollee” and “provider” have the meanings ascribed thereto in subsection A of § 38.2-3407.10.\n\t\t\t“Network pharmacy” means a pharmacy that has agreed to provide pharmacy services to enrollees with an expectation of receiving payments, other than coinsurance, copayments, or deductibles, directly or indirectly from the carrier under the terms of a provider contract.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":207040,"text":"Any health plan providing prescription drug coverage in the Commonwealth shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications, provided that such a proration for any prescription shall not occur more frequently than annually.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":207041,"text":"No health plan providing prescription drug coverage shall deny coverage for the dispensing of a medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications. The health plan shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of synchronizing the enrollee’s medications.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":207042,"text":"No health plan providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copay or fee paid for synchronization services.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":207043,"text":"This section shall apply with respect to health plans that are entered into, amended, extended, or renewed on or after January 1, 2019.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":207044,"text":"Pursuant to the authority granted by § 38.2-223, the Commission may promulgate such rules and regulations as it may deem necessary to implement this section.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"6":{"id":207045,"text":"The Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance authorized","url":"\/38.2-3401\/","token":"38.2\/34\/1\/38.2-3401","metadata":false},{"id":65240,"structure_id":12994,"section_number":"38.2-3402","catch_line":"Certification to accompany application","url":"\/38.2-3402\/","token":"38.2\/34\/1\/38.2-3402","metadata":false},{"id":83988,"structure_id":12994,"section_number":"38.2-3403","catch_line":"Fraudulent procurement of policy","url":"\/38.2-3403\/","token":"38.2\/34\/1\/38.2-3403","metadata":false},{"id":65279,"structure_id":12994,"section_number":"38.2-3404","catch_line":"Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies","url":"\/38.2-3404\/","token":"38.2\/34\/1\/38.2-3404","metadata":false},{"id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; limitations on disclosure of medical treatment options prohibited","url":"\/38.2-3405\/","token":"38.2\/34\/1\/38.2-3405","metadata":false},{"id":84136,"structure_id":12994,"section_number":"38.2-3405.1","catch_line":"Commonwealth's right to certain accident and sickness benefits","url":"\/38.2-3405.1\/","token":"38.2\/34\/1\/38.2-3405.1","metadata":false},{"id":70730,"structure_id":12994,"section_number":"38.2-3406","catch_line":"Accident and sickness benefits not subject to legal process","url":"\/38.2-3406\/","token":"38.2\/34\/1\/38.2-3406","metadata":false},{"id":84333,"structure_id":12994,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","url":"\/38.2-3406.1\/","token":"38.2\/34\/1\/38.2-3406.1","metadata":false},{"id":67972,"structure_id":12994,"section_number":"38.2-3406.2","catch_line":"Capped benefits under insurance policies and contracts","url":"\/38.2-3406.2\/","token":"38.2\/34\/1\/38.2-3406.2","metadata":false},{"id":76321,"structure_id":12994,"section_number":"38.2-3407","catch_line":"Health benefit programs","url":"\/38.2-3407\/","token":"38.2\/34\/1\/38.2-3407","metadata":false},{"id":66921,"structure_id":12994,"section_number":"38.2-3407.1","catch_line":"Interest on accident and sickness claim proceeds","url":"\/38.2-3407.1\/","token":"38.2\/34\/1\/38.2-3407.1","metadata":false},{"id":58079,"structure_id":12994,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","url":"\/38.2-3407.10\/","token":"38.2\/34\/1\/38.2-3407.10","metadata":false},{"id":66411,"structure_id":12994,"section_number":"38.2-3407.10:1","catch_line":"Processing of new provider applications and reimbursement for services rendered during pendency of a participating provider's credentialing application","url":"\/38.2-3407.10_1\/","token":"38.2\/34\/1\/38.2-3407.10_1","metadata":false},{"id":56463,"structure_id":12994,"section_number":"38.2-3407.10:2","catch_line":"Credentialing of private mental health agencies","url":"\/38.2-3407.10_2\/","token":"38.2\/34\/1\/38.2-3407.10_2","metadata":false},{"id":82372,"structure_id":12994,"section_number":"38.2-3407.11","catch_line":"Access to obstetrician-gynecologists","url":"\/38.2-3407.11\/","token":"38.2\/34\/1\/38.2-3407.11","metadata":false},{"id":70024,"structure_id":12994,"section_number":"38.2-3407.11:1","catch_line":"Access to specialists; 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This law was first created in 2018. The record of its establishment is cataloged in chapter 561<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":false,"refers_to":[{"id":87496,"section_number":"38.2-223","catch_line":"Rules and regulations; orders","order_by":null,"url":"\/38.2-223\/"},{"id":58079,"section_number":"38.2-3407.10","catch_line":"Health care provider panels","order_by":null,"url":"\/38.2-3407.10\/"},{"id":71060,"section_number":"38.2-3407.15","catch_line":"Ethics and fairness in carrier business practices","order_by":null,"url":"\/38.2-3407.15\/"}],"permalink":{"id":215135,"object_type":"law","relational_id":56568,"identifier":"38.2-3407.9:04","token":"38.2\/34\/1\/38.2-3407.9_04","url":"\/38.2-3407.9_04\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.9_04\/","token":"38.2\/34\/1\/38.2-3407.9_04","dublin_core":{"Title":"Medication synchronization","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.9:04","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section:\n\t\t\t“Carrier,” “health plan,” and “provider contract<\/span>” have the meanings ascribed thereto in subsection A of § 38.2-3407.15<\/a>.\n\t\t\t“Enrollee” and “provider” have the meanings ascribed thereto in subsection A of § 38.2-3407.10<\/a>.\n\t\t\t“Network pharmacy<\/span>” means a pharmacy that has agreed to provide pharmacy services to enrollees with an expectation of receiving payments, other than coinsurance, copayments, or deductibles, directly or indirectly from the carrier under the terms of a provider contract<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any health plan providing prescription drug coverage in the Commonwealth shall permit and apply a prorated daily cost-sharing rate<\/span> to prescriptions that are dispensed by a network pharmacy<\/span> for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications, provided that such a proration for any prescription shall not occur more frequently than annually. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> No health plan providing prescription drug coverage shall deny coverage for the dispensing of a medication that is dispensed by a network pharmacy<\/span> on the basis that the dispensing is for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee’s medications. The health plan shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of synchronizing the enrollee’s medications. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> No health plan providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copay or fee paid for synchronization services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> This section shall apply with respect to health plans that are entered into, amended, extended, or renewed on or after January 1, 2019. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Pursuant to the authority granted by § 38.2-223<\/a>, the Commission<\/span> may promulgate such rules and regulations as it may deem necessary to implement this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> The Commission<\/span> shall have no jurisdiction<\/span> to adjudicate<\/span> individual controversies arising out of this section. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nMEDICATION SYNCHRONIZATION (\u00a7 38.2-3407.9:04)\n\nA. As used in this section:\n\t\t\t“Carrier,” “health plan,” and “provider\ncontract” have the meanings ascribed thereto in subsection A of §\n38.2-3407.15.\n\t\t\t“Enrollee” and “provider” have the meanings ascribed\nthereto in subsection A of § 38.2-3407.10.\n\t\t\t“Network pharmacy” means a pharmacy that has agreed to provide\npharmacy services to enrollees with an expectation of receiving payments, other\nthan coinsurance, copayments, or deductibles, directly or indirectly from the\ncarrier under the terms of a provider contract.\n\nB. Any health plan providing prescription drug coverage in the Commonwealth\nshall permit and apply a prorated daily cost-sharing rate to prescriptions that\nare dispensed by a network pharmacy for a partial supply if the prescribing\nprovider or the pharmacist determines the fill or refill to be in the best\ninterest of the enrollee and the enrollee requests or agrees to a partial supply\nfor the purpose of synchronizing the enrollee’s medications, provided that\nsuch a proration for any prescription shall not occur more frequently than\nannually.\n\nC. No health plan providing prescription drug coverage shall deny coverage for\nthe dispensing of a medication that is dispensed by a network pharmacy on the\nbasis that the dispensing is for a partial supply if the prescribing provider or\nthe pharmacist determines the fill or refill to be in the best interest of the\nenrollee and the enrollee requests or agrees to a partial supply for the purpose\nof synchronizing the enrollee’s medications. The health plan shall allow a\npharmacy to override any denial codes indicating that a prescription is being\nrefilled too soon for the purposes of synchronizing the enrollee’s\nmedications.\n\nD. No health plan providing prescription drug coverage shall use payment\nstructures incorporating prorated dispensing fees. Dispensing fees for partially\nfilled or refilled prescriptions shall be paid in full for each prescription\ndispensed, regardless of any prorated copay or fee paid for synchronization\nservices.\n\nE. This section shall apply with respect to health plans that are entered into,\namended, extended, or renewed on or after January 1, 2019.\n\nF. Pursuant to the authority granted by § 38.2-223, the Commission may\npromulgate such rules and regulations as it may deem necessary to implement this\nsection.\n\nG. The Commission shall have no jurisdiction to adjudicate individual\ncontroversies arising out of this section.\n\nHISTORY: 2018, c. 561.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}