(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.
Structure New York Laws
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
3201 - Approval of Life, Accident and Health, Credit Unemployment, and Annuity Policy Forms.
3202 - Withdrawal of Approval of Policy Forms.
3205 - Insurable Interest in the Person; Consent Required; Exceptions.
3206 - Policies Which Provide for an Adjustable Maximum Rate of Interest on Policy Loans.
3208 - Antedating of Life Insurance Policies and Burial Agreements Prohibited.
3209 - Life Insurance, Annuities and Funding Agreements Disclosure Requirements.
3210 - Incontestability After Reinstatement.
3212 - Exemption of Proceeds and Avails of Certain Insurance and Annuity Contracts.
3214 - Interest Upon Proceeds of Life Insurance Policies and Annuity Contracts.
3215 - Disability Benefits in Connection With Life Insurance and Annuities.
3216 - Individual Accident and Health Insurance Policy Provisions.
3217-A - Disclosure of Information.
3217-C - Primary and Preventive Obstetric and Gynecologic Care.
3217-D - Grievance Procedure and Access to Specialty Care.
3217-E - Choice of Health Care Provider.
3217-F - Prohibition on Lifetime and Annual Limits.
3217-G - Maternal Depression Screenings.
3217-H - Telehealth Delivery of Services.
3217-I - Essential Health Benefits Package and Limit on Cost-Sharing.
3217-J - Utilization Review Determinations for Medically Fragile Children.
3218 - Medicare Supplemental Insurance Policies.
3220 - Group Life Insurance Policies; Standard Provisions.
3221 - Group or Blanket Accident and Health Insurance Policies; Standard Provisions.
3224 - Standard Claim Forms; Accident and Health Insurance.
3224-B - Rules Relating to the Processing of Health Claims and Overpayments to Physicians.
3224-C - Coordination of Benefits.
3224-D - Prescription Synchronization.
3225 - Eligibility for Health Insurance in Cases of Exposure to Des.
3226 - Reinsurance Contracts Excepted.
3227 - Interest Upon Surrenders, Policy Loans and Other Funds.
3228 - Individual Accident and Health Insurance Policies; Premium Refund at Death of Insured.
3229 - Minimum Benefit Standards for Certain Long Term Care Plans.
3231 - Rating of Individual and Small Group Health Insurance Policies; Approval of Superintendent.
3231*2 - Health Insurance Policies and Subscriber Contracts; Prohibited Claims.
3232 - Pre-Existing Condition Provisions in Health Policies.
3232-A - Certification of Creditable Coverage.
3233 - Stabilization of Health Insurance Markets and Premium Rates.
3234 - Pre-Existing Condition Provisions in Group and Blanket Disability Policies.
3234*2 - Limitations on Administrative Services and Stop-Loss Coverage.
3236 - Public Health Law Assessments.
3237 - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.
3238 - Pre-Authorization of Health Care Services.
3240*2 - Student Accident and Health Insurance.
3242 - Prescription Drug Coverage.
3245 - Liability to Providers in the Event of an Insolvency.