N.Y. Insurance Law Section 4303-A
Prescription synchronization


(a)

Every hospital service corporation and health service corporation 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 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.

Source: Section 4303-A — Prescription synchronization, https://www.­nysenate.­gov/legislation/laws/ISC/4303-A (updated Jan. 10, 2020; accessed Dec. 21, 2024).

4301
Organization of corporation
4302
Permit and license to do business
4303
Benefits
4303‑A
Prescription synchronization
4304
Individual contracts
4305
Group contracts
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
4307
Providers of services
4308
Supervision of superintendent
4309
Limitation on expenses
4310
Investments
4312
Employment of solicitors
4313
Applicability of other provisions of this chapter
4314
Not to affect provisions of workers’ compensation law
4315
Arbitration
4316
Individual contracts
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
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations prior to October first, two t...
4321‑A
Fund for standardized individual enrollee direct payment contracts
4322
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations which provide out-of-plan ben...
4322‑A
Fund for standardized individual enrollee direct payment contracts which provide out-of-plan benefits
4323
Marketing materials
4324
Disclosure of information
4325
Prohibitions
4326
Standardized health insurance contracts for qualifying small employers and individuals
4327
Stop loss funds for standardized health insurance contracts issued to qualifying small employers and qualifying individuals
4328
Individual enrollee direct payment contracts offered by health maintenance organization on and after October first, two thousand thirteen
4329
Prescription drug coverage
4330
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance

Accessed:
Dec. 21, 2024

Last modified:
Jan. 10, 2020

§ 4303-A’s source at nysenate​.gov

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