Ohio § 3923.602

§ 3923.602.

(A) As used in this section: (1) “ Cost-sharing ” means the cost to an insured under a policy of sickness and accident insurance or

a public employee benefit plan according to any coverage limit, copayment, coinsurance,

deductible, or other out-of-pocket expense requirements imposed by the policy or plan. (2) “Drug” has the same meaning as in section 4729.01 of the Revised Code . (3) “ Medication synchronization ” means a pharmacy service that synchronizes the filling or refilling of prescriptions

in a manner that allows the dispensed drugs to be obtained on the same date each month. (4) “Prescriber” has the same meaning as in section 4729.01 of the Revised Code . (5) “ Prescription ” means a written, electronic, or oral order issued by a prescriber for drugs or combinations

or mixtures of drugs to be used by a particular individual. (B) Notwithstanding section 3901.71 of the Revised Code , each policy of sickness and accident insurance that provides prescription drug coverage

and each public employee benefit plan that provides prescription drug coverage shall

provide for medication synchronization for an insured if all of the following conditions

are met: (1) The insured elects to participate in medication synchronization; (2) The insured, the prescriber, and a pharmacist at a network pharmacy agree that medication

synchronization is in the best interest of the insured; (3) The prescription drug to be included in the medication synchronization meets the

requirements of division (C) of this section. (C) To be eligible for inclusion in medication synchronization for an insured, a prescription

drug must meet all of the following requirements: (1) Be covered by the policy or plan; (2) Be prescribed for the treatment and management of a chronic disease or condition

and be subject to refills; (3) Satisfy all relevant prior authorization criteria; (4) Not have quantity limits, dose optimization criteria, or other requirements that

would be violated if synchronized; (5) Not have special handling or sourcing needs, as determined by the policy or plan,

that require a single, designated pharmacy to fill or refill the prescription; (6) Be formulated so that the quantity or amount dispensed can be effectively divided

in order to achieve synchronization; (7) Not be a schedule II controlled substance, opioid analgesic, or benzodiazepine, as

those terms are defined in section 3719.01 of the Revised Code . (D)(1) To provide for medication synchronization under division (B) of this section, a policy

or plan shall authorize coverage of a prescription drug subject to medication synchronization

when the drug is dispensed in a quantity or amount that is less than a thirty-day

supply. (2) The requirement of division (D)(1) of this section applies only once for each prescription

drug subject to medication synchronization for the same insured, except when either

of the following occurs: (a) The prescriber changes the dosage or frequency of administration of the prescription

drug subject to medication synchronization. (b) The prescriber prescribes a different drug. (E)(1) A policy or plan that provides for medication synchronization under division (B)

of this section shall permit and apply a prorated daily cost-sharing rate for a supply

of a prescription drug subject to medication synchronization that is dispensed at

a network pharmacy. (2) Division (E)(1) of this section does not require a policy or plan to waive any cost-sharing

requirements in its entirety. (F) A policy or plan that provides for medication synchronization under division (B)

of this section shall not use payment structures that incorporate dispensing fees

that are determined by calculating the days' supply of drugs dispensed.  Dispensing fees shall be based exclusively on the total number of prescriptions

that are filled or refilled. (G) This section does not require a sickness and accident insurer or public employee

benefit plan to provide to a network pharmacy or a pharmacist at a network pharmacy

any monetary or other financial incentive for the purpose of encouraging the pharmacy

or pharmacist to recommend medication synchronization to an insured.