Bill Text: CT SB00857 | 2013 | General Assembly | Comm Sub
Bill Title: An Act Concerning The Use Of Step Therapy For And Off-label Prescribing Of Prescription Drugs.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2013-04-04 - File Number 340 [SB00857 Detail]
Download: Connecticut-2013-SB00857-Comm_Sub.html
General Assembly |
Raised Bill No. 857 | ||
January Session, 2013 |
LCO No. 2756 | ||
*_____SB00857INS___032013____* | |||
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 CONCERNING THE USE OF STEP THERAPY FOR AND OFF-LABEL PRESCRIBING OF 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 Section 38a-510 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) No individual health insurance policy [issued on an individual basis, whether issued] delivered, issued for delivery, renewed, amended or continued in this state by an insurance company, a hospital service corporation, a medical service corporation or a health care center, [which] that provides coverage for prescription drugs may 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.
[(b) The provisions 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.]
(b) No such policy may require any person covered under such policy to use any alternative brand name prescription drugs or over-the-counter drugs prior to using a brand name prescription drug prescribed by a licensed physician, except that such policy may require any person covered under such policy to use a therapeutically-equivalent generic drug prior to using a brand name prescription drug prescribed by a licensed physician.
(c) (1) If such policy requires the use of step therapy, such policy may not (A) require failure on the same prescription drug more than once, or (B) impose a copayment greater than the lowest cost copayment for preferred drugs in the same class on any person covered under such policy who has satisfied, in the judgment of the prescribing physician, the step therapy requirements of such policy. For purposes of this subsection, "step therapy" means protocols that establish specific sequences for the prescribing of prescription drugs for a specified medical condition.
(2) Nothing in subdivision (1) of this subsection shall be construed to prohibit the use of tiered copayments for any person covered under such policy who is not subject to the use of step therapy.
Sec. 2. Section 38a-544 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) No group medical benefits contract [on a group basis, whether issued] delivered, issued for delivery, renewed, amended or continued in this state by an insurance company, a hospital service corporation, a medical service corporation or a health care center, [which] that provides coverage for prescription drugs may require any person covered under such contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for such drugs.
[(b) The provisions 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.]
(b) No such policy may require any person covered under such policy to use any alternative brand name prescription drugs or over-the-counter drugs prior to using a brand name prescription drug prescribed by a licensed physician, except that such policy may require any person covered under such policy to use a therapeutically-equivalent generic drug prior to using a brand name prescription drug prescribed by a licensed physician.
(c) (1) If such policy requires the use of step therapy, such policy may not (A) require failure on the same prescription drug more than once, or (B) impose a copayment greater than the lowest cost copayment for preferred drugs in the same class on any person covered under such policy who has satisfied, in the judgment of the prescribing physician, the step therapy requirements of such policy. For purposes of this subsection, "step therapy" means protocols that establish specific sequences for the prescribing of prescription drugs for a specified medical condition.
(2) Nothing in subdivision (1) of this subsection shall be construed to prohibit the use of tiered copayments for any person covered under such policy who is not subject to the use of step therapy.
Sec. 3. Section 38a-492b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) Each individual health insurance policy delivered, issued for delivery, renewed, amended or continued in this state, that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for treatment of certain types of cancer or disabling or life-threatening chronic diseases, shall not exclude coverage of any such drug on the basis that such drug has been prescribed for the treatment of a type of cancer or a disabling or life-threatening chronic disease for which the drug has not been approved by the federal Food and Drug Administration, provided the drug is recognized for treatment of the specific type of cancer or a disabling or life-threatening chronic disease for which the drug has been prescribed in one of the following established reference compendia: (1) The U.S. Pharmacopoeia Drug Information Guide for the Health Care Professional (USP DI); (2) The American Medical Association's Drug Evaluations (AMA DE); or (3) The American Society of Hospital Pharmacists' American Hospital Formulary Service Drug Information (AHFS-DI).
(b) Such policy shall not require, as a condition of coverage, the use of any prescription drug for a condition for which such drug has not been approved by the federal Food and Drug Administration, unless such drug is prescribed by such person's treating health care provider.
[(b)] (c) Nothing in subsection (a) of this section shall be construed to require coverage for any experimental or investigational drugs or any drug which the federal Food and Drug Administration has determined to be contraindicated for treatment of the specific type of cancer or disabling or life-threatening chronic disease for which the drug has been prescribed.
[(c)] (d) Except as specified, nothing in this section shall be construed to create, impair, limit or modify authority to provide reimbursement for drugs used in the treatment of any other disease or condition.
Sec. 4. Section 38a-518b of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2014):
(a) Each group health insurance policy delivered, issued for delivery, renewed, amended or continued in this state, that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for treatment of certain types of cancer or disabling or life-threatening chronic diseases, shall not exclude coverage of any such drug on the basis that such drug has been prescribed for the treatment of a type of cancer or a disabling or life-threatening chronic disease for which the drug has not been approved by the federal Food and Drug Administration, provided the drug is recognized for treatment of the specific type of cancer or a disabling or life-threatening chronic disease for which the drug has been prescribed in one of the following established reference compendia: (1) The U.S. Pharmacopoeia Drug Information Guide for the Health Care Professional (USP DI); (2) The American Medical Association's Drug Evaluations (AMA DE); or (3) The American Society of Hospital Pharmacists' American Hospital Formulary Service Drug Information (AHFS-DI).
(b) Such policy shall not require, as a condition of coverage, the use of any prescription drug for a condition for which such drug has not been approved by the federal Food and Drug Administration, unless such drug is prescribed by such person's treating health care provider.
[(b)] (c) Nothing in subsection (a) of this section shall be construed to require coverage for any experimental or investigational drugs or any drug which the federal Food and Drug Administration has determined to be contraindicated for treatment of the specific type of cancer or a disabling or life-threatening chronic disease for which the drug has been prescribed.
[(c)] (d) Except as specified, nothing in this section shall be construed to create, impair, limit or modify authority to provide reimbursement for drugs used in the treatment of any other disease or condition.
This act shall take effect as follows and shall amend the following sections: | ||
Section 1 |
January 1, 2014 |
38a-510 |
Sec. 2 |
January 1, 2014 |
38a-544 |
Sec. 3 |
January 1, 2014 |
38a-492b |
Sec. 4 |
January 1, 2014 |
38a-518b |
INS |
Joint Favorable |