or facility. Oral WAC Plan may not impose dollar limits, copayments, deductibles or Prescription Drug Chemotherapy coinsurance requirements on coverage for orally administered Services(EHB) (Cont’d) anticancer or chemotherapy that are less favorable to an (Cont’d) enrollee than those that apply to coverage for anticancer medication or chemotherapy that is administered intravenously or by injection. WAC Issuer may not reclassify an anticancer medication or increase an enrollee's out-of-pocket as a method of compliance with these requirements. Prescription RCW Issuer must have a prescription synchronization/coordination policy Synchronization 48.43.096(1) for the dispensing of prescription to the plan's enrollees. 48.43.096 If an enrollee requests medication synchronization for a new (1)(a) prescription, the health plan must permit filling the drug: 48.43.096 for less than a supply of the drug if synchronization will (1)(a)(i) require more than a fifteen-day supply of the drug; or 48.43.096 for more than a supply of the drug if synchronization (1)(a)(ii) will require a fifteen-day supply of the drug or less. 48.43.096 The health benefit plan adjust the enrollee cost-sharing for a (1)(b) prescription drug subject to coinsurance that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications. RCW 48.43.096 The health benefit plan shall adjust the enrollee cost-sharing for a (1)(c) prescription drug with a copayment that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications by: (1)(c)(i) Discounting the copayment rate by fifty percent; 48.43.096 Discounting the copayment rate based on fifteen-day increments; (1)(c)(ii) or
or facility. Prescription Drug Services(EHB) (Cont’d) Oral Chemotherapy (Cont’d) WAC Plan may not impose dollar limits, copayments, deductibles or coinsurance requirements on coverage for orally administered anticancer or chemotherapy that are less favorable to an enrollee than those that apply to coverage for anticancer medication or chemotherapy that is administered intravenously or by injection. WAC Issuer may not reclassify an anticancer medication or increase an enrollee's out-of-pocket as a method of compliance with these requirements. Prescription Synchronization RCW 48.43.096(1) Issuer must have a prescription synchronization/coordination policy for the dispensing of prescription to the plan's enrollees. 48.43.096 (1)(a) If an enrollee requests medication synchronization for a new prescription, the health plan must permit filling the drug: 48.43.096 (1)(a)(i) for less than a supply of the drug if synchronization will require more than a fifteen-day supply of the drug; or 48.43.096 (1)(a)(ii) for more than a supply of the drug if synchronization will require a fifteen-day supply of the drug or less. 48.43.096 (1)(b) The health benefit plan adjust the enrollee cost-sharing for a prescription drug subject to coinsurance that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications. RCW 48.43.096 (1)(c) The health benefit plan shall adjust the enrollee cost-sharing for a prescription drug with a copayment that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications by: (1)(c)(i) Discounting the copayment rate by fifty percent; 48.43.096 (1)(c)(ii) Discounting the copayment rate based on fifteen-day increments; or
cl-forms-19-hmo-sg-analyst-checklist.docx