The law requires pharmacies in a patient’s plan to supply medicine when a mail-order delivery is more than one day late or arrives unusable.
Pharmacies in a patient’s plan must supply medicine when mailed prescriptions arrive unusable or more than one day late. Late deliveries qualify for up to seven days’ supply or the smallest prepackaged supply.
Patients receiving medicine under either rule cannot be charged more than one copayment, coinsurance payment, or other out-of-pocket payment for dispensing that prescription.
Pharmacy benefit managers, which manage prescription coverage, must allow these fills. Pharmacies in the plan’s network must supply the medicine. These rules cover people with prescription coverage who use a mail-order pharmacy. For a late delivery, the pharmacy must provide up to a seven-day supply or the smallest prepackaged supply. If medicine arrives unusable, the pharmacy must supply it according to the patient’s prescription. The late-delivery rule applies more than one day after the expected delivery date given by the mail-order pharmacy.
Patients receiving medicine under either rule cannot be charged more than the total of one copayment, coinsurance payment, or other out-of-pocket payment for dispensing that prescription. The limit covers patients receiving medicine from a pharmacy in their plan because a mailed prescription is more than one day late or arrives unusable.
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