Bill Text: CT SB00379 | 2018 | General Assembly | Introduced
Bill Title: An Act Limiting Changes To Health Insurers' Prescription Drug Formularies.
Spectrum: Committee Bill
Status: (Introduced - Dead) 2018-04-18 - File Number 575 [SB00379 Detail]
Download: Connecticut-2018-SB00379-Introduced.html
General Assembly |
Raised Bill No. 379 | ||
February Session, 2018 |
LCO No. 1737 | ||
*01737_______INS* | |||
Referred to Committee on INSURANCE AND REAL ESTATE |
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Introduced by: |
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(INS) |
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AN ACT LIMITING CHANGES TO HEALTH INSURERS' PRESCRIPTION DRUG FORMULARIES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Section 38a-492f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2019):
Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), [and] (12) and (16) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for outpatient prescription drugs shall not [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. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies] remove any covered prescription drug from its list of covered drugs or reclassify or place the drug in a higher cost-sharing tier for the duration of the policy term, except a covered prescription drug may be removed from the list if (1) (A) the drug is not medically necessary, (B) the health carrier that delivered, issued, renewed, amended or continued the policy provides the insured and the insured's prescribing health care provider with at least sixty days' advance written notice of its intended action, and (C) the insured's prescribing health care provider agrees that the drug is not medically necessary, or (2) the drug is identified as no longer safe and effective by the federal Food and Drug Administration or by peer-reviewed medical literature generally recognized by the relevant medical community. Nothing in this section shall be construed to prohibit the addition of prescription drugs to such policy's list of covered drugs during a policy term, provided the addition does not affect such covered prescription drugs, or the classification or cost-sharing tier of such drugs, already on the list during the policy term.
Sec. 2. Section 38a-518f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2019):
Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11), [and] (12) and (16) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for outpatient prescription drugs shall not [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. Such benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies] remove any covered prescription drug from its list of covered drugs or reclassify or place the drug in a higher cost-sharing tier for the duration of the policy term, except a covered prescription drug may be removed from the list if (1) (A) the drug is not medically necessary, (B) the health carrier that delivered, issued, renewed, amended or continued the policy provides the insured and the insured's prescribing health care provider with at least sixty days' advance written notice of its intended action, and (C) the insured's prescribing health care provider agrees that the drug is not medically necessary, or (2) the drug is identified as no longer safe and effective by the federal Food and Drug Administration or by peer-reviewed medical literature generally recognized by the relevant medical community. Nothing in this section shall be construed to prohibit the addition of prescription drugs to such policy's list of covered drugs during a policy term, provided the addition does not affect such covered prescription drugs, or the classification or cost-sharing tier of such drugs, already on the list during the policy term.
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 |
Statement of Purpose:
To limit when an insurer may change prescription drug formularies during the term of certain group and individual health insurance policies.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]