Synchronization of prescription drug refills
(1) As used in this section:
(a) “Health plan” means:
(A) A “health benefit plan” as defined in ORS 743B.005 (Definitions); and
(B) A self-insured health plan offered by the Oregon Health and Science University.
(b) “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.
(2) A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan’s enrollees.
(3) A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan’s synchronization policy.
(4) 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:
(a) Prorate the copayment; or
(b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.
(5) A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.
(6) This section does not apply to prescription drugs that:
(a) Are in unit-of-use packaging for which synchronization is not possible;
(b) Are controlled substances; or
(c) Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.
(7) The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.
(8)(a) This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.
(b) 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. [2014 c.25 §2; 2015 c.800 §1; 2017 c.309 §6]
Note: 743B.601 (Synchronization of prescription drug refills) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.