<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1636" title_number="15" title_name="Health Insurance" subtitle_number="16" subtitle_name="Pharmacy Benefits Managers">
  <level label="a">
    <text>A pharmacy benefits manager or its agent shall cancel and reverse a therapeutic interchange on written or verbal instructions from a prescriber, the beneficiary, or the beneficiary’s representative.</text>
  </level>
  <level label="b">
    <text>If a therapeutic interchange is reversed, the pharmacy benefits manager or its agent shall:</text>
    <level label="1">
      <text>obtain a prescription for and dispense the originally prescribed prescription drug; and</text>
    </level>
    <level label="2">
      <text>charge the beneficiary no more than one copayment.</text>
    </level>
  </level>
  <level label="c">
    <text>If the therapeutic interchange occurred through a mail order pharmacy and a beneficiary will exhaust an existing supply of the originally prescribed prescription drug before a replacement shipment will arrive to the beneficiary, the pharmacy benefits manager or its agent shall arrange for dispensing of an appropriate quantity of replacement prescription drugs at a local community pharmacy at no additional cost to the beneficiary.</text>
  </level>
  <level label="d">
    <text>A pharmacy benefits manager or its agent may not be required to cancel and reverse a therapeutic interchange if a beneficiary is unwilling to pay a higher copayment or coinsurance associated with the originally prescribed prescription drug.</text>
  </level>
</section>
