Connecticut Seal

General Assembly

Amendment

 

February Session, 2018

LCO No. 4206

   
 

*SB0037904206SDO*

Offered by:

 

SEN. LOONEY, 11th Dist.

SEN. FASANO, 34th Dist.

SEN. BYE, 5th Dist.

SEN. GERRATANA, 6th Dist.

SEN. KENNEDY, 12th Dist.

SEN. SOMERS, 18th Dist.

REP. RITTER M., 1st Dist.

REP. COOK, 65th Dist.

REP. JOHNSON, 49th Dist.

REP. TERCYAK, 26th Dist.

To: Subst. Senate Bill No. 379

File No. 575

Cal. No. 349

"AN ACT LIMITING CHANGES TO HEALTH INSURERS' PRESCRIPTION DRUG FORMULARIES."

Strike everything after the enacting clause and substitute the following in lieu thereof:

"Section 1. Section 38a-492f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2019):

(a) [Each] No individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for outpatient prescription drugs shall, [not] during a policy term, (1) deny coverage for an insured for any drug that the insurer removes from its list of covered drugs, [or otherwise ceases to provide coverage for, if (1) the insured was using the drug for the treatment of a chronic illness prior to the removal or cessation of coverage, (2) the insured was covered under the policy for the drug prior to the removal or cessation of coverage, and (3) the insured's attending health care provider states in writing, after the removal or cessation of coverage, that the drug is medically necessary and lists the reasons why the drug is more medically beneficial than the drugs on the list of covered drugs.] or (2) if such policy imposes a coinsurance, copayment, deductible or other out-of-pocket expense that is more than forty dollars for any prescription drug, reclassify a drug by moving the drug to a higher cost-sharing tier. The provisions of this section shall apply if the insured was covered under such policy for a drug and was using the drug prior to the removal or reclassification. The provisions of this section shall not apply if the insured's attending health care provider states, in writing, that a drug is no longer medically necessary or prescribes another therapeutically equivalent drug on the list of covered drugs. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.

(b) Except as provided in subsection (a) of this section, an insurer may reclassify a drug by moving the drug to a higher cost-sharing tier or remove a drug from the insurer's list of covered drugs, provided the insurer shall provide to each insured and participating provider at least ninety days' advance written notice of such reclassification or removal.

(c) Nothing in this section shall be construed as prohibiting:

(1) An insurer from removing a drug from the insurer's list of covered drugs if (A) the federal Food and Drug Administration determines that the drug is no longer safe and effective, or (B) the federal Food and Drug Administration or the manufacturer of such drug withdraws such drug from the market;

(2) An insurer from adding a drug to the insurer's list of covered drugs including, but not limited to, a generic or multisource brand name prescription drug that is therapeutically equivalent to a drug on such list; or

(3) A health care provider from prescribing another drug on an insurer's list of covered drugs that the provider deems medically necessary.

Sec. 2. Section 38a-518f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2019):

(a) [Each] No group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for outpatient prescription drugs shall, [not] during the policy term, (1) deny coverage for an insured for any drug that the insurer removes from its list of covered drugs, [or otherwise ceases to provide coverage for, if (1) the insured was using the drug for the treatment of a chronic illness prior to the removal or cessation of coverage, (2) the insured was covered under the policy for the drug prior to the removal or cessation of coverage, and (3) the insured's attending health care provider states in writing, after the removal or cessation of coverage, that the drug is medically necessary and lists the reasons why the drug is more medically beneficial than the drugs on the list of covered drugs.] or (2) if such policy imposes a coinsurance, copayment, deductible or other out-of-pocket expense that is more than forty dollars for any prescription drug, reclassify a drug by moving the drug to a higher cost-sharing tier. The provisions of this section shall apply if the insured was covered under such policy for a drug and was using the drug prior to the removal or reclassification. The provisions of this section shall not apply if the insured's attending health care provider states, in writing, that a drug is no longer medically necessary or prescribes another therapeutically equivalent drug on the list of covered drugs. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.

(b) Except as provided in subsection (a) of this section, an insurer may reclassify a drug by moving the drug to a higher cost-sharing tier or remove a drug from the insurer's list of covered drugs, provided the insurer shall provide to each insured and participating provider at least ninety days' advance written notice of such reclassification or removal.

(c) Nothing in this section shall be construed as prohibiting:

(1) An insurer from removing a drug from the insurer's list of covered drugs if (A) the federal Food and Drug Administration determines that the drug is no longer safe and effective, or (B) the federal Food and Drug Administration or the manufacturer of such drug withdraws such drug from the market;

(2) An insurer from adding a drug to the insurer's list of covered drugs including, but not limited to, a generic or multisource brand name prescription drug that is therapeutically equivalent to a drug on such list; or

(3) A health care provider from prescribing another drug on an insurer's list of covered drugs that the provider deems medically necessary."

This act shall take effect as follows and shall amend the following sections:

Section 1

January 1, 2019

38a-492f

Sec. 2

January 1, 2019

38a-518f