(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 hospital service corporation or health service corporation
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 hospital service corporation or health service
corporation providing prescription drug coverage 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 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations
4301 - Organization of Corporation; Purposes; Board of Directors.
4302 - Permit and License to Do Business.
4303-A - Prescription Synchronization.
4306 - Required Contract Provisions.
4306-A - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.
4306-B - Primary and Preventive Obstetric and Gynecologic Care.
4306-C - Grievance Procedure and Access to Specialty Care.
4306-D - Choice of Health Care Provider.
4306-E - Prohibition on Lifetime and Annual Limits.
4306-F - Maternal Depression Screenings.
4306-G - Telehealth Delivery of Services.
4306-H - Essential Health Benefits Package and Limit on Cost-Sharing.
4306-I - Coverage for Medically Fragile Children.
4308 - Supervision of Superintendent.
4309 - Limitation on Expenses.
4310 - Investments; Financial Conditions; Reserves.
4312 - Employment of Solicitors; Pension Plans.
4313 - Applicability of Other Provisions of This Chapter.
4314 - Not to Affect Provisions of Workers' Compensation Law.
4315 - Arbitration; Judicial Review.
4316 - Individual Contracts; Premium Refund at Death of Insured.
4317 - Rating of Individual and Small Group Health Insurance Contracts.
4318 - Pre-Existing Condition Provisions.
4318-A - Certification of Creditable Coverage by Corporations Organized Under This Article.
4320 - Limitations on Administrative Services and Stop-Loss Coverage.
4321-A - Fund for Standardized Individual Enrollee Direct Payment Contracts.
4324 - Disclosure of Information.
4326 - Standardized Health Insurance Contracts for Qualifying Small Employers and Individuals.