| 4 | 23 | | |
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| 5 | 24 | | AN ACT CONCERNING HEALTH INSURANCE COVERAGE OF PRESCRIPTION DRUGS FOR PAIN TREATMENT. |
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| 6 | 25 | | |
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| 7 | 26 | | Be it enacted by the Senate and House of Representatives in General Assembly convened: |
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| 8 | 27 | | |
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| 9 | 28 | | Section 1. Section 38a-492i of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2012): |
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| 10 | 29 | | |
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| 11 | 30 | | (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after January 1, 2001,] shall provide access to a pain management specialist and coverage for pain treatment ordered by such specialist [which] that may include all means medically necessary to make a diagnosis and develop a treatment plan including the use of necessary medications and procedures. |
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| 12 | 31 | | |
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| 13 | 32 | | (b) (1) No such policy that provides coverage for prescription drugs shall require an insured to use, prior to using a brand name prescription drug prescribed by a licensed physician for pain treatment, any alternative brand name prescription drugs or over-the-counter drugs. |
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| 14 | 33 | | |
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| 15 | 34 | | (2) Such policy may require an insured to use, prior to using a brand name prescription drug prescribed by a licensed physician for pain treatment, a therapeutically equivalent generic drug. |
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| 16 | 35 | | |
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| 17 | 36 | | (c) As used in this section, "pain" means a sensation in which a person experiences severe discomfort, distress or suffering due to provocation of sensory nerves, and "pain management specialist" means a physician who is credentialed by the American Academy of Pain Management or who is a board-certified anesthesiologist, neurologist, oncologist or radiation oncologist with additional training in pain management. |
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| 18 | 37 | | |
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| 19 | 38 | | Sec. 2. Section 38a-518i of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2012): |
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| 20 | 39 | | |
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| 21 | 40 | | (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [on or after January 1, 2001,] shall provide access to a pain management specialist and coverage for pain treatment ordered by such specialist [which] that may include all means medically necessary to make a diagnosis and develop a treatment plan including the use of necessary medications and procedures. |
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| 22 | 41 | | |
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| 23 | 42 | | (b) (1) No such policy that provides coverage for prescription drugs shall require an insured to use, prior to using a brand name prescription drug prescribed by a licensed physician for pain treatment, any alternative brand name prescription drugs or over-the-counter drugs. |
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| 24 | 43 | | |
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| 25 | 44 | | (2) Such policy may require an insured to use, prior to using a brand name prescription drug prescribed by a licensed physician for pain treatment, a therapeutically equivalent generic drug. |
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| 26 | 45 | | |
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| 27 | 46 | | (c) As used in this section, "pain" means a sensation in which a person experiences severe discomfort, distress or suffering due to provocation of sensory nerves, and "pain management specialist" means a physician who is credentialed by the American Academy of Pain Management or who is a board-certified anesthesiologist, neurologist, oncologist or radiation oncologist with additional training in pain management. |
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