ORS 743B.601 Synchronization of prescription drug refills

As used in this section:

“Health plan” means:

A “health benefit plan” as defined in ORS 743B.005; and

A self-insured health plan offered by the Oregon Health and Science University.

“Synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.

A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan’s enrollees.

A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan’s synchronization policy.

If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient’s prescription drug refills, a health plan shall:

Prorate the copayment; or

Adjust the copayment using a method approved by the Department of Consumer and Business Services.

A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.

This section does not apply to prescription drugs that:

Are in unit-of-use packaging for which synchronization is not possible;

Are controlled substances; or

Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.

The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.

This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.

As used in this subsection, “prepaid group practice health plan” means a health care service contractor that provides physician services to its enrollees through an integrated health care delivery system using, primarily, a single group of physicians contracted on a prepaid, capitated basis.