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General Assembly Substitute Bill No. 6096
January Session, 2019
AN ACT LIMITING CHANGES TO PRESCRIPTION DRUG
FORMULARIES AND LIST S OF COVERED DRUGS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective January 1, 2020) (a) For the purposes of 1
this section: 2
(1) "Affordable Care Act" has the same meaning as provided in 3
section 38a-1080 of the general statutes; 4
(2) "Health benefit plan" has the same meaning as provided in 5
section 38a-1080 of the general statutes, except that such term shall not 6
include a grandfathered health plan as such term is used in the 7
Affordable Care Act; and 8
(3) "Health carrier" has the same meaning as provided in section 9
38a-1080 of the general statutes. 10
(b) Notwithstanding any provision of the general statutes and 11
except as provided in subsection (c) of this section, no health carrier 12
offering a health benefit plan in this state on or after January 1, 2020, 13
that includes a pharmacy benefit and uses a drug formulary or list of 14
covered drugs shall: 15
(1) Remove a prescription drug from the drug formulary or list of 16 Substitute Bill No. 6096
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covered drugs during a plan year; or 17
(2) Move a prescription drug from a cost-sharing tier that imposes a 18
lesser coinsurance, copayment or deductible for the prescription drug 19
to a cost-sharing tier that imposes a greater coinsurance, copayment or 20
deductible for such prescription drug during a plan year. 21
(c) A health carrier offering a health benefit plan in this state on or 22
after January 1, 2020, that includes a pharmacy benefit and uses a drug 23
formulary or list of covered drugs may: 24
(1) Remove a prescription drug from the drug formulary or list of 25
covered drugs if: 26
(A) The prescription drug is not approved by the federal Food and 27
Drug Administration; 28
(B) The federal Food and Drug Administration issues an 29
announcement, guidance, notice, warning or statement concerning the 30
prescription drug that calls into question the clinical safety of such 31
prescription drug; or 32
(C) The prescription drug is approved by the federal Food and Drug 33
Administration for use without a prescription; and 34
(2) Move a brand name prescription drug from a cost-sharing tier 35
that imposes a lesser coinsurance, copayment or deductible for the 36
brand name prescription drug to a cost-sharing tier that imposes a 37
greater coinsurance, copayment or deductible for such brand name 38
prescription drug if the health carrier adds to such drug formulary or 39
list of covered drugs a generic prescription drug: 40
(A) That is approved by the federal Food and Drug Administration 41
for use as an alternative to such brand name prescription drug; and 42
(B) In a cost-sharing tier that will impose a coinsurance, copayment 43
or deductible for the generic prescription drug that is lesser than the 44 Substitute Bill No. 6096
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coinsurance, copayment or deductible that will be imposed for such 45
brand name prescription drug. 46
(d) Nothing in this section shall be construed to prevent or prohibit 47
a health carrier from adding a prescription drug to a formulary or list 48
of covered drugs at any time. 49
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 New section
INS Joint Favorable Subst.