Bill Text: CT HB05251 | 2014 | General Assembly | Introduced

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Bill Title: An Act Limiting Out-of-pocket Expenses For Prescription Drugs.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2014-02-28 - Public Hearing 03/06 [HB05251 Detail]

Download: Connecticut-2014-HB05251-Introduced.html

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General Assembly		Raised Bill No. 5251
February Session, 2014		LCO No. 1041
		*01041_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

AN ACT LIMITING OUT-OF-POCKET EXPENSES FOR PRESCRIPTION DRUGS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 38a-510 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2015):

(a) [No health insurance policy issued on an individual basis, whether issued by an insurance company, a hospital service corporation, a medical service corporation or a health care center, which] No individual health insurance policy delivered, issued for delivery, renewed, amended or continued in this state that provides coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 and provides coverage for prescription drugs may: [require]

(1) Require any person covered under such policy to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for such drugs;

(2) Impose a coinsurance, copayment, deductible or other out-of-pocket expense that, in the aggregate, exceeds one hundred dollars per thirty-day supply for a covered prescription drug; or

(3) Impose annual coinsurance, copayment, deductible or other out-of-pocket expenses that, in the aggregate, exceed fifty per cent of the applicable cost-sharing amount set forth in Section 1302 of the Patient Protection and Affordable Care Act, P.L. 111-1448, as amended from time to time.

(b) The provisions of subdivisions (2) and (3) of subsection (a) of this section shall [apply to any such policy delivered, issued for delivery, renewed, amended or continued in this state on or after July 1, 2005] not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.

Sec. 2. Section 38a-544 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2015):

(a) [No medical benefits contract on a group basis, whether issued by an insurance company, a hospital service corporation, a medical service corporation or a health care center, which] No group health insurance policy delivered, issued for delivery, renewed, amended or continued in this state that provides coverage of the type specified in subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 and provides coverage for prescription drugs may: [require]

(1) Require any person covered under such [contract] policy to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for such drugs;

(2) Impose a coinsurance, copayment, deductible or other out-of-pocket expense that, in the aggregate, exceeds one hundred dollars per thirty-day supply for a covered prescription drug; or

(3) Impose annual coinsurance, copayment, deductible or other out-of-pocket expenses that, in the aggregate, exceed fifty per cent of the applicable cost-sharing amount set forth in Section 1302 of the Patient Protection and Affordable Care Act, P.L. 111-1448, as amended from time to time.

(b) The provisions of subdivisions (2) and (3) of subsection (a) of this section shall [apply to any such medical benefits contract delivered, issued for delivery or renewed in this state on or after July 1, 1989] not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-520.

This act shall take effect as follows and shall amend the following sections:
Section 1	January 1, 2015	38a-510
Sec. 2	January 1, 2015	38a-544

Statement of Purpose:

To limit coinsurance, copayment, deductible or other out-of-pocket expenses imposed on insureds for covered prescription drugs.

[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.]