I. An individual or group health insurance plan or policy providing prescription drug coverage in New Hampshire, shall permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a 30-day supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a 30-day supply for the purpose of synchronizing the patient’s medications. For the purposes of this paragraph, the insured’s or enrollee’s maintenance prescription drugs to be synchronized shall meet all of the following requirements:
(a) They are covered by the policy, certificate, or contract described in this chapter.
(b) They are used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee.
(c) Except as otherwise provided in this paragraph, they are not a controlled substance included in schedules II-V.
(d) They meet all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured’s or enrollee’s multiple, maintenance-prescription drugs.
(e) They are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.
(f) They do not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
II. The plan or policy described in paragraph I shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
III. The plan or policy described in paragraph I shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.
IV. A synchronization shall only occur once per year per maintenance-prescription drug.
Source. 2018, 103:2, eff. Jan. 1, 2019.