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General Assembly Raised Bill No. 7174
January Session, 2019
LCO No. 4454
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING PR ESCRIPTION DRUGS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective October 1, 2019) (a) For the purposes of 1
this section: 2
(1) "Drug" has the same meaning as provided in section 21a-92 of 3
the general statutes; 4
(2) "Participating individual" means an individual resident of this 5
state who is participating in the program; 6
(3) "Participating pharmacist" means a pharmacist who is 7
participating in the program; 8
(4) "Participating pharmacy" means a pharmacy that is participating 9
in the program; 10
(5) "Pharmacist" has the same meaning as provided in section 38a-11
479aaa of the general statutes; 12
(6) "Pharmacy" has the same meaning as provided in section 38a-13
479aaa of the general statutes; 14 Raised Bill No. 7174
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(7) "Pharmacy benefits manager" has the same meaning as provided 15
in section 38a-479aaa of the general statutes; 16
(8) "Program" means the Connecticut Prescription Drug Program 17
established by the Comptroller pursuant to subsection (b) of this 18
section; and 19
(9) "Program price" means the reimbursement rates and prescription 20
drug prices established under the program. 21
(b) The Comptroller shall, within available appropriations, establish 22
the Connecticut Prescription Drug Program. The purposes of the 23
program shall be to: (1) Purchase outpatient prescription drugs, 24
replenish supplies of outpatient prescription drugs or reimburse 25
participating pharmacies and participating pharmacists for outpatient 26
prescription drugs in order to secure the lowest possible prices and 27
greatest possible rebates for outpatient prescription drugs prescribed 28
to participating individuals; (2) make outpatient prescription drugs 29
available at the lowest possible cost to participating individuals; (3) 30
maintain a list of the most cost-effective and therapeutically effective 31
outpatient prescription drugs available to participating individuals; (4) 32
purchase and provide discounted outpatient prescription drugs to 33
participating individuals; and (5) coordinate a comprehensive 34
pharmacy benefit for participating individuals. 35
(c) (1) As part of the program, the Comptroller shall: (A) Establish 36
eligibility criteria for individual residents of this state, as well as 37
pharmacies and pharmacists, to participate in the program; (B) 38
prescribe an application form for (i) individual residents of this state to 39
become participating individuals, (ii) pharmacists to become 40
participating pharmacists, and (iii) pharmacies to become participating 41
pharmacies; (C) issue to participating individuals a prescription drug 42
identification card containing the information necessary for claims 43
processing; (D) establish a list of preferred outpatient prescription 44
drugs for the program; (E) negotiate with pharmaceutical 45
manufacturers and other persons to secure discounts and rebates for 46 Raised Bill No. 7174
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outpatient prescription drugs; (F) establish program prices; (G) 47
adjudicate pharmacy claims and reimburse participating pharmacies 48
and participating pharmacists at program prices; (H) develop a system 49
for allocating and distributing the operational costs of the program, as 50
well as any rebates, to participating individuals; and (I) charge 51
administrative fees to participating individuals, participating 52
pharmacists and participating pharmacies to cover the operational 53
costs of the program, and deposit such fees in the account established 54
under section 2 of this act. 55
(2) As part of the program, the Comptroller may: (A) Purchase 56
outpatient prescription drugs on behalf of participating individuals; or 57
(B) cooperate with other states or regional consortia to purchase 58
outpatient prescription drugs on behalf of participating individuals. 59
(3) The Comptroller may enter into a contract with a pharmacy 60
benefits manager to perform the Comptroller's duties under 61
subdivisions (1) and (2) of this subsection, provided the Comptroller 62
shall require the pharmacy benefits manager to charge such pharmacy 63
benefits manager's lowest available rate to perform such duties. 64
(d) The Comptroller may adopt regulations, in accordance with 65
chapter 54 of the general statutes, to implement the provisions of this 66
section. 67
Sec. 2. (NEW) (Effective October 1, 2019) There is established an 68
account to be known as the "Connecticut prescription drug program 69
account" which shall be a separate, nonlapsing account within the 70
General Fund. The account shall contain any moneys required by law 71
to be deposited in the account. Moneys in the account shall be 72
expended by the Comptroller for the purposes of the Connecticut 73
Prescription Drug Program established pursuant to section 1 of this 74
act. 75
Sec. 3. (NEW) (Effective October 1, 2019) (a) Each pharmaceutical 76
manufacturer doing business in this state that manufactures a brand 77
name prescription drug and enters into an agreement with another 78 Raised Bill No. 7174
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pharmaceutical manufacturer for the purpose of delaying or 79
preventing such other manufacturer from introducing a generic 80
substitute for such drug into the marketplace shall, not later than thirty 81
days after entering into such agreement, send notice to the Insurance 82
Commissioner, in a form and manner prescribed by the commissioner, 83
disclosing the name of such drug. 84
(b) (1) The commissioner shall, not later than thirty days after 85
receiving a notice pursuant to subsection (a) of this section, send notice 86
to each health carrier, as defined in section 38a-1080 of the general 87
statutes, and pharmacy benefits manager, as defined in section 38a-88
479aaa of the general statutes, doing business in this state. Such notice 89
shall, at a minimum: 90
(A) Disclose the name of the brand name prescription drug that is 91
the subject of the notice the commissioner received pursuant to 92
subsection (a) of this section; and 93
(B) Instruct such health carrier, if such health carrier includes such 94
drug on such health carrier's drug formulary or list of covered drugs, 95
or pharmacy benefits manager, if such pharmacy benefits manager 96
administers a prescription drug benefit that includes such drug, to 97
immediately reduce the cost of such drug to covered individuals by an 98
amount that is equal to fifty per cent of the manufacturer's wholesale 99
list price for such drug. 100
(2) For the purposes of this subdivision, "manufacturer's wholesale 101
list price" has the same meaning as provided in section 21a-126 of the 102
general statutes. 103
(c) The provisions of this section shall apply to the maximum extent 104
permitted by applicable law. 105
(d) The commissioner may adopt regulations, in accordance with 106
chapter 54 of the general statutes, to implement the provisions of this 107
section. 108 Raised Bill No. 7174
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Sec. 4. Subdivision (3) of subsection (m) of section 5-259 of the 109
general statutes is repealed and the following is substituted in lieu 110
thereof (Effective October 1, 2019): 111
(3) (A) [(i)] For the purposes of this subdivision: 112
(i) "Nonstate public employer" means (I) a municipality or other 113
political subdivision of the state, including a board of education, quasi-114
public agency or public library, as defined in section 11-24a, or (II) the 115
Teachers' Retirement Board; and 116
(ii) "Qualified private employer" means a self-insured private 117
employer doing business in this state. 118
(B) The Comptroller shall offer nonstate public employers and 119
qualified private employers the option to purchase prescription drugs 120
for their employees, employees' dependents and retirees under the 121
purchasing authority of the state pursuant to section 1 of public act 09-122
206, subject to the provisions of subparagraph [(E)] (F) of this 123
subdivision. [(ii) For purposes of this subdivision, "nonstate public 124
employer" means (I) a municipality or other political subdivision of the 125
state, including a board of education, quasi-public agency or public 126
library, as defined in section 11-24a, or (II) the Teachers' Retirement 127
Board.] 128
[(B)] (C) The Comptroller shall establish procedures to determine (i) 129
the eligibility requirements for, (ii) the enrollment procedures for, (iii) 130
the duration of, (iv) requirements regarding payment for, and (v) the 131
procedures for withdrawal from and termination of, the purchasing of 132
prescription drugs for nonstate public employers and qualified private 133
employers under subparagraph [(A)] (B) of this subdivision. 134
[(C)] (D) The Comptroller may offer to nonstate public employers 135
and qualified private employers that choose to purchase prescription 136
drugs pursuant to subparagraph [(A)] (B) of this subdivision the 137
option to purchase stop loss coverage from an insurer at a rate 138
negotiated by the Comptroller. 139 Raised Bill No. 7174
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[(D)] (E) Two or more nonstate public employers or qualified 140
private employers may join together for the purpose of purchasing 141
prescription drugs for their employees, employees' dependents and 142
retirees. Such arrangement shall not constitute a multiple employer 143
welfare arrangement, as defined in Section 3 of the Employee 144
Retirement Income Security Act of 1974, as amended from time to 145
time. 146
[(E)] (F) (i) The Comptroller shall offer nonstate public employers 147
and qualified private employers the option to purchase prescription 148
drugs through the plan set forth in the State Employees' Bargaining 149
Agent Coalition's collective bargaining agreement with the state only if 150
the Health Care Cost Containment Committee, established in 151
accordance with the ratified agreement between the state and said 152
coalition pursuant to subsection (f) of section 5-278, has indicated in 153
writing to the Comptroller that allowing such nonstate public 154
employers and qualified private employers such option is consistent 155
with said coalition's collective bargaining agreement. 156
(ii) Such writing shall not be required if the Comptroller establishes 157
a separate prescription drugs purchasing plan or plans for nonstate 158
public employers and qualified private employers. 159
(iii) Nonstate public employers and qualified private employers that 160
purchase prescription drugs pursuant to this subdivision shall pay the 161
full cost of their own claims and prescription drugs. 162
Sec. 5. Section 38a-477cc of the general statutes is repealed and the 163
following is substituted in lieu thereof (Effective October 1, 2019): 164
(a) [On and after January 1, 2018, no] No contract for pharmacy 165
services entered into in the state between a health carrier, as defined in 166
section 38a-591a, or pharmacy benefits manager, as defined in section 167
38a-479aaa, and a pharmacy or pharmacist shall: 168
(1) On and after January 1, 2018, contain a provision prohibiting or 169
penalizing, including through increased utilization review, reduced 170 Raised Bill No. 7174
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payments or other financial disincentives, a pharmacist's disclosure to 171
an individual purchasing prescription medication of information 172
regarding: 173
[(1) the] (A) The cost of the prescription medication to the 174
individual; [,] or 175
[(2) the] (B) The availability of any therapeutically equivalent 176
alternative medications or alternative methods of purchasing the 177
prescription medication, including, but not limited to, paying a cash 178
price, that are less expensive than the cost of the prescription 179
medication to the individual; [.] and 180
(2) On and after January 1, 2020, contain a provision permitting the 181
health carrier or pharmacy benefits manager to recoup, directly or 182
indirectly, from a pharmacy or pharmacist any portion of a claim that 183
such health carrier or pharmacy benefits manager has paid to the 184
pharmacy or pharmacist, unless such recoupment is permitted under 185
section 38a-479iii or required by applicable law. 186
(b) (1) On and after January 1, 2018, no health carrier or pharmacy 187
benefits manager shall require an individual to make a payment at the 188
point of sale for a covered prescription medication in an amount 189
greater than the lesser of: 190
[(1) the] (A) The applicable copayment for such prescription 191
medication; [,] 192
[(2) the] (B) The allowable claim amount for the prescription 193
medication; [,] or 194
[(3) the] (C) The amount an individual would pay for the 195
prescription medication if the individual purchased the prescription 196
medication without using a health benefit plan, as defined in section 197
38a-591a, or any other source of prescription medication benefits or 198
discounts. 199
(2) For the purposes of this subsection, "allowable claim amount" 200 Raised Bill No. 7174
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means the amount the health carrier or pharmacy benefits manager 201
has agreed to pay the pharmacy for the prescription medication. 202
(c) Any provision of a contract that violates the provisions of this 203
section shall be void and unenforceable. Any general business practice 204
that violates the provisions of this section shall constitute an unfair 205
trade practice pursuant to chapter 735a. The invalidity or 206
unenforceability of any contract provision under this subsection shall 207
not affect any other provision of the contract. 208
(d) The Insurance Commissioner may: [, (1) pursuant to the 209
provisions of chapter 697, enforce] 210
(1) Enforce the provisions of this section [,] pursuant to chapter 697; 211
and 212
(2) [upon] Upon request, audit a contract for pharmacy services for 213
compliance with the provisions of this section. 214
Sec. 6. (Effective from passage) (a) There is established a task force to 215
study drug reimportation. Such study shall include, but need not be 216
limited to, an examination of the feasibility of implementing a drug 217
reimportation program for the purpose of lowering the cost of 218
prescription drugs and health insurance in this state. 219
(b) The task force shall consist of the following members: 220
(1) Two appointed by the speaker of the House of Representatives; 221
(2) Two appointed by the president pro tempore of the Senate; 222
(3) One appointed by the majority leader of the House of 223
Representatives; 224
(4) One appointed by the majority leader of the Senate; 225
(5) One appointed by the minority leader of the House of 226
Representatives; 227 Raised Bill No. 7174
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(6) One appointed by the minority leader of the Senate; 228
(7) The Attorney General, or the Attorney General's designee; 229
(8) The Comptroller, or the Comptroller's designee; 230
(9) The Insurance Commissioner, or the commissioner's designee; 231
(10) The Commissioner of Public Health, or the commissioner's 232
designee; 233
(11) The Commissioner of Social Services, or the commissioner's 234
designee; 235
(12) The executive director of the Office of Health Strategy, or the 236
executive director's designee; 237
(13) The Healthcare Advocate, or the Healthcare Advocate's 238
designee; and 239
(14) Two persons appointed by the Governor. 240
(c) Any member of the task force appointed under subdivision (1), 241
(2), (3), (4), (5) or (6) of subsection (b) of this section may be a member 242
of the General Assembly. 243
(d) All appointments to the task force shall be made not later than 244
thirty days after the effective date of this section. Any vacancy shall be 245
filled by the appointing authority. 246
(e) The speaker of the House of Representatives and the president 247
pro tempore of the Senate shall select the chairpersons of the task force 248
from among the members of the task force. Such chairpersons shall 249
schedule the first meeting of the task force, which shall be held not 250
later than sixty days after the effective date of this section. 251
(f) The administrative staff of the joint standing committee of the 252
General Assembly having cognizance of matters relating to insurance 253
shall serve as administrative staff of the task force. 254 Raised Bill No. 7174
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(g) Not later than January 1, 2020, the task force shall submit a 255
report on its findings and recommendations to the joint standing 256
committee of the General Assembly having cognizance of matters 257
relating to insurance, in accordance with the provisions of section 11-258
4a of the general statutes. The task force shall terminate on the date 259
that it submits such report or January 1, 2020, whichever is later.260
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2019 New section
Sec. 2 October 1, 2019 New section
Sec. 3 October 1, 2019 New section
Sec. 4 October 1, 2019 5-259(m)(3)
Sec. 5 October 1, 2019 38a-477cc
Sec. 6 from passage New section
Statement of Purpose:
To: (1) Establish the "Connecticut Prescription Drug Program" and the
"Connecticut prescription drug program account"; (2) require
pharmaceutical manufacturers to send notice to the Insurance
Commissioner regarding "pay-for-delay" agreements, and require
health carriers and pharmacy benefits managers to reduce the cost of
brand name prescription drugs that are the subject of such agreements;
(3) require the Comptroller to offer qualified private employers the
option to purchase prescription drugs for their employees, employees'
dependents and retirees through the Comptroller's purchasing
authority; (4) prohibit any health carrier or pharmacy benefits manager
from recouping any portion of a claim that such carrier or manager has
paid to a pharmacy or pharmacist; and (5) establish a task force to
study drug reimportation.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
not underlined.]