Cancellation and reversal

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    (a)    A pharmacy benefits manager or its agent shall cancel and reverse a therapeutic interchange on written or verbal instructions from a prescriber, the beneficiary, or the beneficiary’s representative.

    (b)    If a therapeutic interchange is reversed, the pharmacy benefits manager or its agent shall:

        (1)    obtain a prescription for and dispense the originally prescribed prescription drug; and

        (2)    charge the beneficiary no more than one copayment.

    (c)    If the therapeutic interchange occurred through a mail order pharmacy and a beneficiary will exhaust an existing supply of the originally prescribed prescription drug before a replacement shipment will arrive to the beneficiary, the pharmacy benefits manager or its agent shall arrange for dispensing of an appropriate quantity of replacement prescription drugs at a local community pharmacy at no additional cost to the beneficiary.

    (d)    A pharmacy benefits manager or its agent may not be required to cancel and reverse a therapeutic interchange if a beneficiary is unwilling to pay a higher copayment or coinsurance associated with the originally prescribed prescription drug.


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