MISSISSIPPI LEGISLATURE
2017 Regular Session
To: Insurance
By: Representatives Mims, Mettetal
AN ACT TO PROVIDE THAT INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES PROVIDING PRESCRIPTION DRUG COVERAGE MUST PERMIT AND APPLY A PRORATED DAILY COST-SHARING RATE TO PRESCRIPTIONS THAT ARE DISPENSED BY A NETWORK PHARMACY FOR A PARTIAL SUPPLY IF THE PRESCRIBER OR PHARMACIST DETERMINES THE FILL OR REFILL TO BE IN THE BEST INTEREST OF THE PATIENT AND THE PATIENT REQUESTS OR AGREES TO A PARTIAL SUPPLY FOR THE PURPOSE OF SYNCHRONIZING THE PATIENT'S MEDICATIONS; TO PROHIBIT INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES FROM DENYING 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; TO PROVIDE THAT INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES MUST ALLOW A PHARMACY TO OVERRIDE ANY DENIAL CODES INDICATING THAT A PRESCRIPTION IS BEING REFILLED TOO SOON FOR THE PURPOSES OF MEDICATION SYNCHRONIZATION; TO PROVIDE THAT INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES MUST USE PAYMENT STRUCTURES INCORPORATING PRORATED DISPENSING FEES; TO PROVIDE THAT DISPENSING FEES FOR PARTIALLY FILLED OR REFILLED PRESCRIPTIONS MUST BE PAID IN FULL FOR EACH PRESCRIPTION DISPENSED; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) An individual or group health insurance policy providing prescription drug coverage in the state must permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient's medications.
(2) No individual or group health insurance policy 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 prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient's medications. The individual or group health insurance policy must allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for the purposes of medication synchronization.
(3) No individual or group health insurance policy 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 for the beneficiary or fee paid for alignment services.
SECTION 2. This act shall take effect and be in force from and after July 1, 2017.