Early eye drop refill legal protection

Early eye drop prescription refills laws that may help glaucoma patients have been enacted in 29 U.S. states. These laws are important because they require health care insurers to cover for early refills if the initial prescription is covered under a patient’s health plan .

HOUSE BILL 16-1095 CONCERNING HEALTH INSURANCE COVERAGE FOR EARLY REFILLS OF PRESCRIPTION EYE DROPS .

Be it enacted by the General Assembly of the State of Colorado:

SECTION 1. In Colorado Revised Statutes, 10-16-104, add (22) as follows:

10-16-104. Mandatory coverage provisions - definitions - rules.

(22) Prescription eye drop refill coverage. (a) ANY HEALTH BENEFIT PLAN, EXCEPT SUPPLEMENTAL POLICIES COVERING A SPECIFIED DISEASE OR OTHER LIMITED BENEFIT, THAT PROVIDES COVERAGE FOR PRESCRIPTION EYE DROPS SHALL PROVIDE COVERAGE FOR:

(I) A RENEWAL OF PRESCRIPTION EYE DROPS IF:

(A) T HE RENEWAL IS REQUESTED BY THE INSURED AT LEAST

TWENTY- ONE DAYS FOR A THIRTY - DAY SUPPLY OF EYE DROPS ,

FORTY- TWO DAYS FOR A SIXTY - DAY SUPPLY OF EYE DROPS , OR

SIXTY- THREE DAYS FOR A NINETY- DAY SUPPLY OF EYE DROPS,

FROM THE LATER OF THE DATE THAT THE ORIGINAL PRESCRIPTION WAS DISTRIBUTED TO THE INSURED OR THE DATE THAT THE LAST RENEWAL OF THE PRESCRIPTION WAS DISTRIBUTED TO THE INSURED ; AND

(B) THE ORIGINAL PRESCRIPTION STATES THAT ADDITIONAL QUANTITIES ARE NEEDED AND THE RENEWAL REQUESTED BY THE INSURED DOES NOT EXCEED THE NUMBER OF ADDITIONAL QUANTITIES NEEDED; AND (II) ONE ADDITIONAL BOTTLE OF PRESCRIPTION EYE DROPS IF:

(A) A BOTTLE IS REQUESTED BY THE INSURED OR THE HEALTH CARE PROVIDER AT THE TIME THE ORIGINAL PRESCRIPTION IS FILLED ; AND

(B) T HE ORIGINAL PRESCRIPTION STATES THAT ONE ADDITIONAL BOTTLE IS NEEDED BY THE INSURED FOR USE IN A DAY CARE CENTER , SCHOOL, OR ADULT DAY PROGRAM. T HE ADDITIONAL BOTTLE IS LIMITED TO ONE BOTTLE EVERY THREE MONTHS .

(b) T HE PRESCRIPTION EYE DROP BENEFITS COVERED UNDER THIS SUBSECTION (22) ARE SUBJECT TO THE SAME ANNUAL DEDUCTIBLES , COPAYMENT , OR COINSURANCE ESTABLISHED FOR ALL OTHER PRESCRIPTION DRUG BENEFITS UNDER THE HEALTH BENEFIT PLAN .