20-1057.16. Prescription eyedrops; refills

A. Beginning January 1, 2018, any evidence of coverage that is issued, delivered or renewed by a health care services organization and that provides coverage for prescription eyedrops to treat glaucoma or ocular hypertension may not deny coverage for a refill of a prescription for eyedrops to treat glaucoma or ocular hypertension if all of the following apply:

1. The enrollee requests the refill:

(a) For a thirty-day supply, at least twenty-three days and less than thirty days from the later of:

(i) The original date that the prescription was distributed to the enrollee.

(ii) The date of the most recent refill that was distributed to the enrollee.

(b) For a sixty-day supply, at least forty-five days and less than sixty days from the later of:

(i) The original date that the prescription was distributed to the enrollee.

(ii) The date of the most recent refill that was distributed to the enrollee.

(c) For a ninety-day supply, at least sixty-eight days and less than ninety days from the later of:

(i) The original date that the prescription was distributed to the enrollee.

(ii) The date of the most recent refill that was distributed to the enrollee.

2. The prescription eyedrops to treat glaucoma or ocular hypertension prescribed by the health care provider are a covered benefit under the enrollee's evidence of coverage.

3. The prescribing health care provider indicates on the original prescription that additional quantities of the prescription eyedrops to treat glaucoma or ocular hypertension are needed.

4. The refill requested by the enrollee does not exceed the number of additional quantities prescribed.

B. To the extent practicable, the requirements of this section are limited in quantity to the remaining dosage initially approved for coverage, except that any limited refilling may not limit or restrict coverage to any previously or subsequently approved prescription eyedrops to treat glaucoma or ocular hypertension and is subject to the terms and conditions of the evidence of coverage that are applicable to this coverage.