Virginia HB 234: Health insurance; synchronization of medications.

Bill Text

Bill Tracking - 2018 session > Legislation 

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2018 SESSION

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18100454D

HOUSE BILL NO. 234 

Offered January 10, 2018 

Prefiled December 31, 2017 

A BILL to amend the Code of Virginia by adding a section 
 numbered 38.2-3407.9:04, relating to health benefit plans; prescription drug 
 coverage; synchronization of medications. 
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Patrons-- Hope and Adams, D.M. 

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Referred to Committee on Commerce and Labor 

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Be it enacted by the General Assembly of Virginia: 

1. That the Code of Virginia is amended by adding a section 
 numbered 38.2-3407.9:04 as follows: 

� 38.2-3407.9:04. Medication 
 synchronization.

A. As used in 
 this section:

"Carrier," 
 "health plan," and 
 "provider contract" have the meanings ascribed thereto in subsection 
 A of � 38.2-3407.15.

"Enrollee" and 
 "provider" have the meanings ascribed thereto in subsection A of � 
 38.2-3407.10.

"Network pharmacy" means a 
 pharmacy that has agreed to provide pharmacy services 
 to enrollees with an expectation of 
 receiving payments, other than coinsurance, copayments, or deductibles, 
 directly or indirectly from the carrier under the terms of a 
 provider contract.

B. Any health plan providing 
 prescription drug coverage in the Commonwealth shall permit and 
 apply a prorated daily cost-sharing rate to prescriptions that are dispensed by 
 a network pharmacy for a partial supply if the prescribing 
 provider or the pharmacist determines 
 the fill or refill to be in the best interest of the enrollee and the enrollee requests 
 or agrees to a partial supply for the purpose of synchronizing the enrollee's 
 medications.

C. No health plan providing 
 prescription drug coverage shall deny coverage for the dispensing of a 
 medication that is dispensed by a network pharmacy on the basis that the 
 dispensing is for a partial supply if the prescribing 
 provider or the pharmacist 
 determines the fill or refill to be in the best interest of the enrollee and the enrollee requests 
 or agrees to a partial supply for the purpose of synchronizing the enrollee's 
 medications. The health plan shall allow a 
 pharmacy to override any denial codes indicating that a prescription is being 
 refilled too soon for the purposes of synchronizing the 
 enrollee's medications.

D. No health plan providing 
 prescription drug coverage shall use payment structures incorporating prorated 
 dispensing fees. Dispensing fees for partially filled or refilled prescriptions 
 shall be paid in full for each prescription dispensed, regardless of any 
 prorated copay or fee paid for synchronization services.

E. This section shall apply 
 with respect to health plans that are entered into, 
 amended, extended, or renewed on or after January 1, 2019.

F. Pursuant to 
 the authority granted by � 38.2-223, the Commission may promulgat