| 18 | | - | 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 and imposes a coinsurance, copayment, deductible or other out-of-pocket expense that is more than forty dollars for any covered prescription drug 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. |
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| 30 | + | 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. |
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