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Current as of January 01, 2023 | Updated by Findlaw Staff
(1) As used in this section:
(a) “Health plan” means:
(A) A “health benefit plan” as defined in ORS 743B.005; and
(B) A self-insured health plan offered by the Public Employees' Benefit Board, the Oregon Educators Benefit Board or the Oregon Health and Science University.
(b) “Synchronization policy” means a procedure for aligning the refill dates of a patient's prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently.
(2) A health plan that includes prescription drug coverage shall implement a synchronization policy for the dispensing of prescription drugs to the plan's enrollees.
(3) A health plan shall reimburse the cost of prescription drugs dispensed in accordance with the plan's synchronization policy.
(4) If a drug is dispensed in less than a 30-day supply for the purpose of synchronizing a patient's prescription drug refills, a health plan shall:
(a) Prorate the copayment; or
(b) Adjust the copayment using a method approved by the Department of Consumer and Business Services.
(5) A health plan shall fully reimburse the dispensing fee for partially filled or refilled prescription drugs.
(6) This section does not apply to prescription drugs that:
(a) Are in unit-of-use packaging for which synchronization is not possible;
(b) Are controlled substances; or
(c) Have been identified by the United States Drug Enforcement Administration as having a high risk of diversion.
(7) The coverage required by this section may be limited by formulary restrictions applied to a prescription drug by a health plan.
(8)(a) This section does not apply to a prepaid group practice health plan with at least 200,000 enrollees in this state.
(b) As used in this subsection, “prepaid group practice health plan” means a health care service contractor that provides physician services to its enrollees through an integrated health care delivery system using, primarily, a single group of physicians contracted on a prepaid, capitated basis.
Cite this article: FindLaw.com - Oregon Revised Statutes Insurance § 743B.601 - last updated January 01, 2023 | https://codes.findlaw.com/or/title-56-insurance/or-rev-st-sect-743b-601/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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