First Substitute S.B. 210

This document includes Senate 2nd Reading Floor Amendments incorporated into the bill on Tue, Mar 4, 2014 at 4:07 PM by bhansen. --> This document includes Senate 3rd Reading Floor Amendments incorporated into the bill on Wed, Mar 5, 2014 at 11:19 AM by lpoole. -->

Senator Curtis S. Bramble proposes the following substitute bill:

1 PRESCRIPTION SYNCHRONIZATION
2 2014 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Curtis S. Bramble
5 House Sponsor: Mike K. McKell
6
7 LONG TITLE
8 General Description:
9 This bill addresses payments by health insurance plans for the synchronization of
10 prescription drug dispensing.
11 Highlighted Provisions:
12 This bill:
13 . provides definitions;
14 . prohibits a health insurance plan that provides prescription drug coverage from
15 excluding certain prescription drugs dispensed in quantities less than the prescribed
16 amount;
17 . prohibits a health insurance plan from basing the dispensing fee for an individual
18 prescription on the quantity of the prescription drug dispensed to fill or refill the
19 prescription; and
20 . requires administrative rulemaking.
21 Money Appropriated in this Bill:
22 None
23 Other Special Clauses:
24 None
25 Utah Code Sections Affected:

Text Box
- 2 -

Senate 2nd Reading Amendments 3-4-2014 bh/cjd 26

ENACTS:
27 31A-22-642, Utah Code Annotated 1953
28
29 Be it enacted by the Legislature of the state of Utah:
30 Section 1. Section 31A-22-642 is enacted to read:
31 31A-22-642. Prescription synchronization -- Copay restrictions.
32 (1) For purposes of this section:
33 (a) "Copay" means the copay normally charged for a prescription drug.
34 (b) "Health insurer" means an insurer, as defined in Subsection 31A-22-634 (1).
35 (c) "Network pharmacy" means a pharmacy included in a health insurance plan's
36 network of pharmacy providers.
37 (d) "Prescription drug" means a prescription drug, as defined in Section 58-17b-102 ,
38 that is prescribed for a chronic condition.
39 (2) A health insurance plan may not charge an amount in excess of the copay for the
40 dispensing of a prescription drug in a quantity less than the prescribed amount if:
41 (a) S. [ the prescriber, or the pharmacist or pharmacy intern, has noted on the prescription
42 that dispensing less than the prescribed amount permits synchronization of the prescription's
43 original or refill dispensing date with the original or refill dispensing date of one or more other
44 prescriptions ] the pharmacy dispenses the prescription drug in accordance with the health
44a insurer's synchronization policy .S ; and
45 (b) the prescription drug is dispensed by a network pharmacy.
46 (3) A health insurance plan that includes a prescription drug benefit:
47 (a) shall implement a synchronization policy for the dispensing of prescription drugs to
48 the plan's enrollees; and
49 (b) may not base the dispensing fee for an individual prescription on the quantity of the
50 prescription drug dispensed to fill or refill the prescription unless otherwise agreed to by the
51 plan and the contracted pharmacy S. [ . ] at the time the individual requests synchronization. .S
52 (4) This section applies to health benefit plans renewed or entered into on or after
53 January 1, 2015.