§ 58‑3‑228. Coverage for extra prescriptions during a state of emergency or disaster.
(a) All health benefitplans as defined in G.S. 58‑3‑167, the State Health Plan forTeachers and State Employees, and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes, and otherstand‑alone prescription medication plans issued by entities that arelicensed by the Department shall have, when an event described in subdivision(b)(1) of this section occurs and the requirements of subdivisions (b)(2) and(b)(3) of this section are satisfied, a procedure in place to waive timerestrictions on filling or refilling prescriptions for medication if requestedby the covered person or subscriber. The procedure shall include waiver oroverride of electronic "refill too soon" edits to pharmacies andshall include provision for payment to the pharmacy in accordance with theprescription benefit plan and applicable pharmacy provider agreement. Theprocedure shall enable covered persons or subscribers to:
(1) Obtain one refill ona prescription if there are authorized refills remaining, or
(2) Fill one replacementprescription for one that was recently filled, as prescribed or approved by theprescriber of the prescription that is being replaced and not contrary to thedispensing authority of the dispensing pharmacy.
(b) All entitiessubject to this section shall authorize payment to pharmacies for anyprescription dispensed in accordance with subsection (a) of this sectionregardless of the date upon which the prescription had most recently beenfilled by a pharmacist, if all of the following conditions apply:
(1) The Commissionerissues a Bulletin Advisory notifying all insurance carriers licensed in thisState of a declared state of disaster or state of emergency in North Carolina.The Department shall provide a copy of the Bulletin to the North Carolina Boardof Pharmacy.
(2) The covered personrequesting coverage of the refill or replacement prescription resides in acounty that:
a. Is covered under aproclamation of state of disaster issued by the Governor or by a resolution ofthe General Assembly under G.S. 166A‑6, or a declaration of majordisaster issued by the President of the United States under the Robert T.Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121, etseq., as amended; or
b. Is declared to beunder a state of emergency in a proclamation issued by the Governor under G.S.14‑288.15.
(3) The prescriptionmedication is requested within 29 days after the origination date of theconditions stated in subdivision (b)(1) of this section.
(c) The time period forthe waiver of prescription medication refills may be extended in 30‑dayincrements by an order issued by the Commissioner. Additional refills stillremaining on a prescription shall be covered by the insurer as long asconsistent with the orders of the prescriber or authority of the dispensingpharmacy.
(d) This section doesnot excuse or exempt an insured or subscriber from any other terms of the policyor certificate providing coverage for prescription medications.
(e) Quantitylimitations shall be consistent with the original prescription and the extra orreplacement fill may recognize proportionate dosage use prior to the disaster.
(f) No requirementsadditional to those under the pharmacy provider agreement or the prescriptionbenefit plan may be placed upon the provider for coverage of the replacementfill or extra fill.
(g) Nothing in thissection is intended to affect the respective authority or scope of practice ofprescribers or pharmacies. (2007‑133, s. 1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
§ 58‑3‑228. Coverage for extra prescriptions during a state of emergency or disaster.
(a) All health benefitplans as defined in G.S. 58‑3‑167, the State Health Plan forTeachers and State Employees, and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes, and otherstand‑alone prescription medication plans issued by entities that arelicensed by the Department shall have, when an event described in subdivision(b)(1) of this section occurs and the requirements of subdivisions (b)(2) and(b)(3) of this section are satisfied, a procedure in place to waive timerestrictions on filling or refilling prescriptions for medication if requestedby the covered person or subscriber. The procedure shall include waiver oroverride of electronic "refill too soon" edits to pharmacies andshall include provision for payment to the pharmacy in accordance with theprescription benefit plan and applicable pharmacy provider agreement. Theprocedure shall enable covered persons or subscribers to:
(1) Obtain one refill ona prescription if there are authorized refills remaining, or
(2) Fill one replacementprescription for one that was recently filled, as prescribed or approved by theprescriber of the prescription that is being replaced and not contrary to thedispensing authority of the dispensing pharmacy.
(b) All entitiessubject to this section shall authorize payment to pharmacies for anyprescription dispensed in accordance with subsection (a) of this sectionregardless of the date upon which the prescription had most recently beenfilled by a pharmacist, if all of the following conditions apply:
(1) The Commissionerissues a Bulletin Advisory notifying all insurance carriers licensed in thisState of a declared state of disaster or state of emergency in North Carolina.The Department shall provide a copy of the Bulletin to the North Carolina Boardof Pharmacy.
(2) The covered personrequesting coverage of the refill or replacement prescription resides in acounty that:
a. Is covered under aproclamation of state of disaster issued by the Governor or by a resolution ofthe General Assembly under G.S. 166A‑6, or a declaration of majordisaster issued by the President of the United States under the Robert T.Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121, etseq., as amended; or
b. Is declared to beunder a state of emergency in a proclamation issued by the Governor under G.S.14‑288.15.
(3) The prescriptionmedication is requested within 29 days after the origination date of theconditions stated in subdivision (b)(1) of this section.
(c) The time period forthe waiver of prescription medication refills may be extended in 30‑dayincrements by an order issued by the Commissioner. Additional refills stillremaining on a prescription shall be covered by the insurer as long asconsistent with the orders of the prescriber or authority of the dispensingpharmacy.
(d) This section doesnot excuse or exempt an insured or subscriber from any other terms of the policyor certificate providing coverage for prescription medications.
(e) Quantitylimitations shall be consistent with the original prescription and the extra orreplacement fill may recognize proportionate dosage use prior to the disaster.
(f) No requirementsadditional to those under the pharmacy provider agreement or the prescriptionbenefit plan may be placed upon the provider for coverage of the replacementfill or extra fill.
(g) Nothing in thissection is intended to affect the respective authority or scope of practice ofprescribers or pharmacies. (2007‑133, s. 1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
§ 58‑3‑228. Coverage for extra prescriptions during a state of emergency or disaster.
(a) All health benefitplans as defined in G.S. 58‑3‑167, the State Health Plan forTeachers and State Employees, and any optional plans or programs operatingunder Part 2 of Article 3 of Chapter 135 of the General Statutes, and otherstand‑alone prescription medication plans issued by entities that arelicensed by the Department shall have, when an event described in subdivision(b)(1) of this section occurs and the requirements of subdivisions (b)(2) and(b)(3) of this section are satisfied, a procedure in place to waive timerestrictions on filling or refilling prescriptions for medication if requestedby the covered person or subscriber. The procedure shall include waiver oroverride of electronic "refill too soon" edits to pharmacies andshall include provision for payment to the pharmacy in accordance with theprescription benefit plan and applicable pharmacy provider agreement. Theprocedure shall enable covered persons or subscribers to:
(1) Obtain one refill ona prescription if there are authorized refills remaining, or
(2) Fill one replacementprescription for one that was recently filled, as prescribed or approved by theprescriber of the prescription that is being replaced and not contrary to thedispensing authority of the dispensing pharmacy.
(b) All entitiessubject to this section shall authorize payment to pharmacies for anyprescription dispensed in accordance with subsection (a) of this sectionregardless of the date upon which the prescription had most recently beenfilled by a pharmacist, if all of the following conditions apply:
(1) The Commissionerissues a Bulletin Advisory notifying all insurance carriers licensed in thisState of a declared state of disaster or state of emergency in North Carolina.The Department shall provide a copy of the Bulletin to the North Carolina Boardof Pharmacy.
(2) The covered personrequesting coverage of the refill or replacement prescription resides in acounty that:
a. Is covered under aproclamation of state of disaster issued by the Governor or by a resolution ofthe General Assembly under G.S. 166A‑6, or a declaration of majordisaster issued by the President of the United States under the Robert T.Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121, etseq., as amended; or
b. Is declared to beunder a state of emergency in a proclamation issued by the Governor under G.S.14‑288.15.
(3) The prescriptionmedication is requested within 29 days after the origination date of theconditions stated in subdivision (b)(1) of this section.
(c) The time period forthe waiver of prescription medication refills may be extended in 30‑dayincrements by an order issued by the Commissioner. Additional refills stillremaining on a prescription shall be covered by the insurer as long asconsistent with the orders of the prescriber or authority of the dispensingpharmacy.
(d) This section doesnot excuse or exempt an insured or subscriber from any other terms of the policyor certificate providing coverage for prescription medications.
(e) Quantitylimitations shall be consistent with the original prescription and the extra orreplacement fill may recognize proportionate dosage use prior to the disaster.
(f) No requirementsadditional to those under the pharmacy provider agreement or the prescriptionbenefit plan may be placed upon the provider for coverage of the replacementfill or extra fill.
(g) Nothing in thissection is intended to affect the respective authority or scope of practice ofprescribers or pharmacies. (2007‑133, s. 1; 2007‑323, s. 28.22A(o);2007‑345, s. 12.)
