Pennsylvania Statutes Title 72 P.S. Taxation and Fiscal Affairs § 3761-515.1. Medication synchronization

(a) Prorated daily cost-sharing fees.--The program shall permit and apply a prorated daily cost-sharing fee to prescription drugs that are dispensed by a pharmacy for less than a 30 days' supply if the pharmacist or prescriber determines the fill or refill to be in the best interest of the program participant and the program participant requests or agrees to less than a 30 days' supply for the purpose of medication synchronization.  The program may not use payment structures incorporating prorated dispensing fees.

(b) Full payment.--Dispensing fees for a partial supply or refilled prescription shall be paid in full for each maintenance medication dispensed, regardless of any prorated copay for the beneficiary or fee paid for alignment services.

(c) Partial supply.--The program may not deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescriber or pharmacist determines the fill or refill is in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of medication synchronization.

(d) Annual limitation.--The fill or refill under this section shall be limited to three times a year for each maintenance medication for a covered individual.  For each clinically necessary synchronization thereafter, approval may be required at the discretion of the program.

(e) Override of denial codes.--Subject to section 520(c.1),  1 the program shall allow a pharmacy to override any denial codes indicating that a prescription drug is being refilled too soon for the purposes of medication synchronization utilizing the submission clarification and message codes as adopted by the National Council for Prescription Drug Programs or alternative codes provided by the program.

(f) Exemption.--This section does not apply to prescription drugs that are either: