Covered insurance plans may not deny refill coverage for topical ophthalmic prescriptions when the refill is requested within the stated day ranges; prescribers must note on the original prescription that extra quantities are needed.
§997.1. Topical ophthalmic prescriptions; coverage for refills A. Any health, hospital, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits, which is delivered, issued for delivery, or renewed in this state on or after January 1, 2017, that provides coverage for topical ophthalmic prescriptions, shall not deny coverage for refills under the following circumstances: (1) The refill is requested by the insured for a thirty-day supply, between twenty-three and thirty days from the later of either: (a) The original date the prescription was distributed to the insured. (b) The date the most recent refill was distributed to the insured. (2) For a sixty-day supply, between forty-six and sixty days from the later of either: (a) The original date the prescription was distributed to the insured. (b) The date the most recent refill was distributed to the insured. (3) For a ninety-day supply, between sixty-nine and ninety days from the later of either: (a) The original date the prescription was distributed to the insured. (b) The date the most recent refill was distributed to the insured. B. The prescriber shall indicate on the original prescription that additional quantities are necessary. However, the original prescription shall not exceed the number of additional quantities necessary for treatment of the medical condition for which the original prescription was issued. C. The provisions of this Section shall, to the extent practicable, be limited in quantity so as not to exceed the remaining dosage initially approved for coverage, provided that such limited refilling shall not limit or restrict coverage with regard to any previously or subsequently approved topical ophthalmic prescription and shall be subject to the terms and conditions of the insurance plan otherwise applicable to this coverage. Acts 2016, No. 206, §1.