Background

As previously communicated on November 25, 2015, effective January 1, 2016, proration of a member’s daily cost share (copayment) in order to support the synchronization of prescription fills is being implemented by select fully-insured commercial and some State Medicaid and Marketplace Plan Sponsors. When implemented by a Plan Sponsor, this functionality will apply a daily cost-sharing rate to a prescription presented to a network pharmacy that is dispensed for less than the plan-defined one-month supply.

IMPORTANT FOR PROVIDERS IN OHIO:

Per OH Gen Assembly Sub. H.B. No.116, Section 1751.68 [Effective 8/31/2016], Provisions for medication synchronization for enrollees: An agreement that provides for medication synchronization by adhering to all of the stated conditions 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.

Please see attached PDF file for more information.