<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1635" title_number="15" title_name="Health Insurance" subtitle_number="16" subtitle_name="Pharmacy Benefits Managers">
  <text>If a therapeutic interchange occurs, the pharmacy benefits manager or its agent shall:</text>
  <level label="1">
    <text>disclose to the beneficiary, orally or in writing:</text>
    <level label="i">
      <text>that the pharmacy benefits manager or its agent requested a therapeutic interchange by contacting the beneficiary’s prescriber;</text>
    </level>
    <level label="ii">
      <text>the prescriber approved the therapeutic interchange;</text>
    </level>
    <level label="iii">
      <text>the names of the originally prescribed drug and the drug dispensed pursuant to the therapeutic interchange;</text>
    </level>
    <level label="iv">
      <text>the difference in copayments or coinsurance to be paid by the beneficiary to obtain the drug dispensed pursuant to the therapeutic interchange;</text>
    </level>
    <level label="v">
      <text>the circumstances under which the originally prescribed drug will be covered;</text>
    </level>
    <level label="vi">
      <text>the circumstances under and the extent to which health care costs related to the therapeutic interchange will be compensated; and</text>
    </level>
    <level label="vii">
      <text>that the beneficiary may decline the therapeutic interchange if the originally prescribed drug remains on the beneficiary’s formulary, and the beneficiary is willing to pay any difference in the copayment or coinsurance; and</text>
    </level>
  </level>
  <level label="2">
    <text>include with the prescription drug dispensed:</text>
    <level label="i">
      <text>a patient package insert about potential side effects; and</text>
    </level>
    <level label="ii">
      <text>a toll–free telephone number to communicate with the pharmacy benefits manager.</text>
    </level>
  </level>
</section>
