"synchronization."
The program may not use payment structures incorporating
prorated dispensing fees.
(b) Full payment.--Dispensing fees for a partial supply or
refilled prescription shall be paid in full for each maintenance
medication dispensed, regardless of any prorated copay for the
beneficiary or fee paid for alignment services.
(c) Partial supply.--The program may not deny coverage for
the dispensing of a maintenance 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 is in the best interest of the patient and the
patient requests or agrees to a partial supply for the purpose
of medication synchronization.
(d) Annual limitation.--The fill or refill under this
section shall be limited to three times a year for each
maintenance medication for a covered individual. For each
clinically necessary synchronization thereafter, approval may be
required at the discretion of the program.
Amend Bill, page 2, line 23, by striking out "(b)" and
inserting
(e)
Amend Bill, page 2, line 23, by striking out "The" and
inserting
Subject to section 520(c.1), the
Amend Bill, page 2, line 26, by striking out the period after
"synchronization" and inserting
utilizing the submission clarification and message codes as
adopted by the National Council for Prescription Drug Programs
or alternative codes provided by the program.
(f) Exemption.--This section does not apply to prescription
drugs that are either:
(1) unit-of-use packaging for which medication
synchronization is not possible; or
(2) controlled substances classified in Schedule II
under section 4(2) of the act of April 14, 1972 (P.L.233,
No.64), known as The Controlled Substance, Drug, Device and
Cosmetic Act.
Amend Bill, page 3, line 3, by striking out "$31,000" and
inserting
$27,500
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