S.F. 2078 Section 1. NEW SECTION . 514C.5A Prescription drug 1 medication synchronization. 2 1. A group policy or contract providing for third-party 3 payment or prepayment for prescription drugs shall permit and 4 apply a prorated daily cost-sharing rate to prescription drugs 5 that are dispensed for less than a thirty-day supply, for 6 the purposes of synchronizing the medications of the person 7 covered under the policy or contract, if the prescriber or 8 pharmacist determines the prorated filling or refilling of the 9 prescription drug to be in the best interest of the person and 10 the person requests or agrees to less than a thirty-day supply. 11 However, the group policy or contract shall not use payment 12 structures incorporating pro rata dispensing fees, and the 13 dispensing fee for partially filled or refilled prescriptions 14 shall be paid based on the full supply of each prescription 15 dispensed, regardless of any prorated copayment paid by the 16 covered person for synchronization of medications. 17 2. A group policy or contract providing for third-party 18 payment or prepayment for prescription drugs shall not deny 19 coverage for the dispensing of multiple prescriptions at one 20 time for the purposes of synchronizing medications for a 21 covered person under the policy or contract, if the person 22 and the pharmacist or other prescriber agree to synchronizing 23 the filling or refilling of multiple prescriptions for the 24 person. The group policy or contract shall allow a pharmacy 25 to override any denial codes indicating that a prescription 26 drug is being refilled too soon for the purposes of medication 27 synchronization. 28 3. A person who provides an individual policy or contract 29 providing for third-party payment or prepayment of health or 30 medical expenses shall make available a coverage provision 31 that satisfies the requirements of this section in the same 32 manner as such requirements are applicable to a group policy 33 or contract under this section. The policy or contract 34 shall provide that the individual policyholder may reject the 35 -1- LSB 5745SS (3) 86 pf/nh 1/ 3

S.F. 2078 coverage provision at the option of the policyholder. 1 4. a. This section applies to the following classes of 2 third-party payment provider contracts or policies delivered, 3 issued for delivery, continued, or renewed in this state on or 4 after January 1, 2017: 5 (1) Individual or group accident and sickness insurance 6 providing coverage on an expense-incurred basis. 7 (2) An individual or group hospital or medical service 8 contract issued pursuant to chapter 509, 514, or 514A. 9 (3) An individual or group health maintenance organization 10 contract regulated under chapter 514B. 11 (4) Any other entity engaged in the business of insurance, 12 risk transfer, or risk retention, which is subject to the 13 jurisdiction of the commissioner. 14 (5) A plan established pursuant to chapter 509A for public 15 employees. 16 (6) An organized delivery system licensed by the director 17 of public health. 18 b. This section shall not apply to accident-only, 19 specified disease, short-term hospital or medical, hospital 20 confinement indemnity, credit, dental, vision, Medicare 21 supplement, long-term care, basic hospital and medical-surgical 22 expense coverage as defined by the commissioner, disability 23 income insurance coverage, coverage issued as a supplement 24 to liability insurance, workers’ compensation or similar 25 insurance, or automobile medical payment insurance. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to insurance coverage for prescription 30 drugs dispensed in a manner to facilitate medication 31 synchronization. The bill requires that a group policy or 32 contract providing for third-party payment or prepayment for 33 prescription drugs apply a prorated daily cost-sharing rate to 34 prescription drugs that are dispensed for less than a 30-day 35 -2- LSB 5745SS (3) 86 pf/nh 2/ 3

S.F. 2078 supply, for the purposes of synchronizing the medications 1 of the person covered under the policy or contract, if the 2 prescriber or pharmacist determines the prorated filling or 3 refilling of the prescription drug to be in the best interest 4 of the person and the person requests or agrees to less than 5 a 30-day supply. However, the group policy or contract shall 6 not use payment structures incorporating pro rata dispensing 7 fees, and the dispensing fee for partially filled or refilled 8 prescriptions shall be paid based on the full supply of each 9 prescription dispensed, regardless of any prorated copayment 10 paid by the covered person for synchronization of medications. 11 The bill also prohibits a group policy or contract providing 12 for third-party payment or prepayment for prescription 13 drugs from denying coverage for the dispensing of multiple 14 prescriptions at one time for the purposes of synchronizing 15 medications for a covered person under the policy or contract, 16 if the person and the pharmacist or other prescriber agree 17 to synchronizing the filling or refilling of multiple 18 prescriptions for the person. The group policy or contract 19 is required to allow a pharmacy to override any denial codes 20 indicating that a prescription drug is being refilled too soon 21 for the purposes of medication synchronization. 22 The bill requires a person who provides an individual policy 23 or contract providing for third-party payment or prepayment 24 of health or medical expenses to make available a coverage 25 provision that satisfies the requirements of the bill in the 26 same manner as such requirements are applicable to a group 27 policy or contract. The policy or contract shall provide that 28 the individual policyholder may reject the coverage provision 29 at the option of the policyholder. 30 The bill specifies the classes of third-party payment 31 provider contracts or policies delivered, issued for delivery, 32 continued, or renewed in this state on or after January 1, 33 2017, to which the bill applies or does not apply. 34 -3- LSB 5745SS (3) 86 pf/nh 3/ 3