                                 CODE OF VIRGINIA

MEDICATION SYNCHRONIZATION (§ 38.2-3407.9:04)

A. As used in this section:
			&#8220;Carrier,&#8221; &#8220;health plan,&#8221; and &#8220;provider
contract&#8221; have the meanings ascribed thereto in subsection A of &#xA7;
38.2-3407.15.
			&#8220;Enrollee&#8221; and &#8220;provider&#8221; have the meanings ascribed
thereto in subsection A of &#xA7; 38.2-3407.10.
			&#8220;Network pharmacy&#8221; 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. 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&#8217;s medications, provided that
such a proration for any prescription shall not occur more frequently than
annually.

C. 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&#8217;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&#8217;s
medications.

D. 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.

E. This section shall apply with respect to health plans that are entered into,
amended, extended, or renewed on or after January 1, 2019.

F. Pursuant to the authority granted by &#xA7; 38.2-223, the Commission may
promulgate such rules and regulations as it may deem necessary to implement this
section.

G. The Commission shall have no jurisdiction to adjudicate individual
controversies arising out of this section.

HISTORY: 2018, c. 561.