S.B. 210
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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 . creates a cap on the copay charged by a health insurance plan for the dispensing of
15 certain prescription drugs in quantities less than a 30-day supply;
16 . prohibits a health insurance plan that provides prescription drug coverage from
17 excluding certain prescription drugs dispensed in quantities less than a 30-day
18 supply;
19 . prohibits a health insurance plan from basing the dispensing fee for an individual
20 prescription on the quantity of the prescription drug dispensed to fill or refill the
21 prescription; and
22 . requires administrative rulemaking.
23 Money Appropriated in this Bill:
24 None
25 Other Special Clauses:
26 None
27 Utah Code Sections Affected:
28 ENACTS:
29 31A-22-642 , Utah Code Annotated 1953
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31 Be it enacted by the Legislature of the state of Utah:
32 Section 1. Section 31A-22-642 is enacted to read:
33 31A-22-642. Prescription synchronization -- Copay restrictions.
34 (1) For purposes of this section:
35 (a) "Copay cap" means the copay normally charged for a 30-day supply of a
36 prescription drug, multiplied by the copay factor for the drug.
37 (b) "Copay factor" means the number of days for which a prescription drug is
38 prescribed, divided by 30.
39 (c) "Health insurer" means an insurer, as defined in Subsection 31A-22-634 (1).
40 (d) "Network pharmacy" means a pharmacy included in a health insurance plan's
41 network of pharmacy providers.
42 (e) "Prescription drug" means a prescription drug, as defined in Section 58-17b-102 ,
43 that is prescribed for a chronic condition.
44 (2) A health insurance plan may not charge a copay in excess of the copay cap for the
45 dispensing of a prescription drug in a quantity less than a 30-day supply if:
46 (a) the prescriber, or the pharmacist or pharmacy intern, has noted on the prescription
47 that prescribing less than a 30-day supply permits synchronization of the prescription's original
48 or refill dispensing date with the original or refill dispensing date of one or more other
49 prescriptions; and
50 (b) the prescription drug is dispensed by a network pharmacy.
51 (3) A health insurance plan that includes a prescription drug benefit:
52 (a) may not exclude from the benefit prescription drugs described in Subsection (2);
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54 (b) may not base the dispensing fee for an individual prescription on the quantity of the
55 prescription drug dispensed to fill or refill the prescription.
56 (4) The commissioner shall make rules in accordance with Title 63G, Chapter 3, Utah
57 Administrative Rulemaking Act, to implement this section, including rules defining "chronic
58 condition" and "network of pharmacy providers," and rules facilitating the notation described
59 in Subsection (2)(a).
60 (5) This section applies to health benefit plans renewed or entered into on or after
61 January 1, 2015.
Legislative Review Note
as of 2-18-14 10:33 AM