2022 New York Laws
ISC - Insurance
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
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.