<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-852" title_number="15" title_name="Health Insurance" subtitle_number="8" subtitle_name="Required Health Insurance Benefits">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“In–network pharmacy” means a pharmacy that is among the participating providers with which an entity subject to this section contracts to provide health care services to members.</text>
    </level>
    <level label="3">
      <text>“Member” means an individual entitled to health care benefits for prescription drugs or devices under a policy issued or delivered in the State by an entity subject to this section.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>This section applies to:</text>
      <level label="i">
        <text>insurers and nonprofit health service plans that provide coverage for prescription drugs and devices under health insurance policies or contracts that are issued or delivered in the State; and</text>
      </level>
      <level label="ii">
        <text>health maintenance organizations that provide coverage for prescription drugs and devices under contracts that are issued or delivered in the State.</text>
      </level>
    </level>
    <level label="2">
      <text>An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs and devices through a pharmacy benefits manager is subject to the requirements of this section.</text>
    </level>
  </level>
  <level label="c">
    <text>An entity subject to this section shall allow and apply a prorated daily copayment or coinsurance amount for a partial supply of a prescription drug dispensed by an in–network pharmacy if:</text>
    <level label="1">
      <text>the prescriber or the pharmacist determines dispensing a partial supply of a prescription drug to be in the best interest of the member;</text>
    </level>
    <level label="2">
      <text>the prescription drug is anticipated to be required for more than 3 months;</text>
    </level>
    <level label="3">
      <text>the member requests or agrees to a partial supply for the purpose of synchronizing the dispensing of the member’s prescription drugs;</text>
    </level>
    <level label="4">
      <text>the prescription drug is not a Schedule II controlled dangerous substance; and</text>
    </level>
    <level label="5">
      <text>the supply and dispensing of the prescription drug meets all prior authorization and utilization management requirements specific to the prescription drug at the time of the synchronized dispensing.</text>
    </level>
  </level>
  <level label="d">
    <text>Subject to subsection (c) of this section, an entity subject to this section:</text>
    <level label="1">
      <text>may not deny payment of benefits to an in–network pharmacy for a covered prescription drug solely on the basis that only a partial supply of the prescription drug was dispensed; and</text>
    </level>
    <level label="2">
      <text>shall allow an in–network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.</text>
    </level>
  </level>
  <level label="e">
    <text>Subject to subsection (c) of this section, an entity subject to this section:</text>
    <level label="1">
      <text>may not use a payment structure that incorporates prorated dispensing fees for dispensing a partial supply of a prescription drug; and</text>
    </level>
    <level label="2">
      <text>shall pay an in–network pharmacy a full dispensing fee for dispensing a partial supply of a prescription drug under this section, regardless of:</text>
      <level label="i">
        <text>any prorated copayment or coinsurance amount charged to a member; or</text>
      </level>
      <level label="ii">
        <text>any fee paid to the pharmacy for synchronizing a member’s prescriptions.</text>
      </level>
    </level>
  </level>
</section>
