Bill Text: CT SB00373 | 2016 | General Assembly | Comm Sub

Connecticut Senate Bill 373 (Prior Session Legislation)

Bill Title: An Act Limiting Changes To Health Insurers' Prescription Drug Formularies.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2016-04-19 - Referred by Senate to Committee on Appropriations [SB00373 Detail]

Download: Connecticut-2016-SB00373-Comm_Sub.html


General Assembly		*Raised Bill No. 373*
*February Session, 2016*		LCO No. 2131
		_____SB00373INS___031716____
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)

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 Section 38a-492f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2017):

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 such drug in a higher cost-sharing tier for the duration of the policy term, except a covered prescription drug may be removed from such list if such 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 such addition shall not affect the covered prescription drugs, or the classification or cost-sharing tier of such drugs, already on such list during such policy term.

Sec. 2. Section 38a-518f of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2017):

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 such drug in a higher cost-sharing tier for the duration of the policy term, except a covered prescription drug may be removed from such list if such 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 such addition shall not affect the covered prescription drugs, or the classification or cost-sharing tier of such drugs, already on such list during such policy term.