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House Bill 1296 |
House Author: Frullo et al. |
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Effective: 9-1-17 |
Senate Sponsor: Buckingham |
House Bill 1296 amends the Insurance Code to require a health benefit plan that provides benefits for prescription drugs, including the child health plan program and the state Medicaid program to the extent allowed by federal law, to prorate any cost-sharing amount charged for a partial supply of a prescription drug if the pharmacy or the enrollee's prescribing physician or health care provider notifies the health benefit plan that the quantity dispensed is to synchronize the dates that the pharmacy dispenses the enrollee's prescription drugs and that the synchronization is in the enrollee's best interest and if the enrollee agrees to the synchronization. The bill applies with respect to only a medication that, in addition to certain other criteria, is used for treatment and management of a chronic illness. The bill prohibits proration of the dispensing fee paid to the pharmacy.
House Bill 1296 requires an applicable health benefit plan to establish a process through which certain parties may jointly approve a medication synchronization plan for medication to treat an enrollee's chronic illness, requires the health benefit plan to provide coverage for a medication dispensed in accordance with the dates established in the medication synchronization plan, and provides for a pharmacist's or pharmacy's ability to override the health benefit plan's denial of coverage for such a medication.