Connecticut 2019 Regular Session

Connecticut House Bill HB06096 Compare Versions

Version 1 (Old)

Version 2 (New)

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7	7		General Assembly Substitute Bill No. 6096
8	8		January Session, 2019
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14	14		AN ACT LIMITING CHANGES TO PRESCRIPTION DRUG
15	15		FORMULARIES AND LIST S OF COVERED DRUGS.
16	16		Be it enacted by the Senate and House of Representatives in General
17	17		Assembly convened:
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19	19		Section 1. (NEW) (Effective January 1, 2020) (a) For the purposes of 1
20	20		this section: 2
21	21		(1) "Affordable Care Act" has the same meaning as provided in 3
22	22		section 38a-1080 of the general statutes; 4
23	23		(2) "Health benefit plan" has the same meaning as provided in 5
24	24		section 38a-1080 of the general statutes, except that such term shall not 6
25	25		include a grandfathered health plan as such term is used in the 7
26	26		Affordable Care Act; and 8
27	27		(3) "Health carrier" has the same meaning as provided in section 9
28	28		38a-1080 of the general statutes. 10
29	29		(b) Notwithstanding any provision of the general statutes and 11
30	30		except as provided in subsection (c) of this section, no health carrier 12
31	31		offering a health benefit plan in this state on or after January 1, 2020, 13
32	32		that includes a pharmacy benefit and uses a drug formulary or list of 14
33	33		covered drugs shall: 15
34	34		(1) Remove a prescription drug from the drug formulary or list of 16 Substitute Bill No. 6096
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41	41		covered drugs during a plan year; or 17
42	42		(2) Move a prescription drug from a cost-sharing tier that imposes a 18
43	43		lesser coinsurance, copayment or deductible for the prescription drug 19
44	44		to a cost-sharing tier that imposes a greater coinsurance, copayment or 20
45	45		deductible for such prescription drug during a plan year. 21
46	46		(c) A health carrier offering a health benefit plan in this state on or 22
47	47		after January 1, 2020, that includes a pharmacy benefit and uses a drug 23
48	48		formulary or list of covered drugs may: 24
49	49		(1) Remove a prescription drug from the drug formulary or list of 25
50	50		covered drugs if: 26
51	51		(A) The prescription drug is not approved by the federal Food and 27
52	52		Drug Administration; 28
53	53		(B) The federal Food and Drug Administration issues an 29
54	54		announcement, guidance, notice, warning or statement concerning the 30
55	55		prescription drug that calls into question the clinical safety of such 31
56	56		prescription drug; or 32
57	57		(C) The prescription drug is approved by the federal Food and Drug 33
58	58		Administration for use without a prescription; and 34
59	59		(2) Move a brand name prescription drug from a cost-sharing tier 35
60	60		that imposes a lesser coinsurance, copayment or deductible for the 36
61	61		brand name prescription drug to a cost-sharing tier that imposes a 37
62	62		greater coinsurance, copayment or deductible for such brand name 38
63	63		prescription drug if the health carrier adds to such drug formulary or 39
64	64		list of covered drugs a generic prescription drug: 40
65	65		(A) That is approved by the federal Food and Drug Administration 41
66	66		for use as an alternative to such brand name prescription drug; and 42
67	67		(B) In a cost-sharing tier that will impose a coinsurance, copayment 43
68	68		or deductible for the generic prescription drug that is lesser than the 44 Substitute Bill No. 6096
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75	75		coinsurance, copayment or deductible that will be imposed for such 45
76	76		brand name prescription drug. 46
77	77		(d) Nothing in this section shall be construed to prevent or prohibit 47
78	78		a health carrier from adding a prescription drug to a formulary or list 48
79	79		of covered drugs at any time. 49
80	80		This act shall take effect as follows and shall amend the following
81	81		sections:
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83	83		Section 1 January 1, 2020 New section
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85	85		INS Joint Favorable Subst.
86		-	APP Joint Favorable
87	86