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General Assembly Committee Bill No. 36
January Session, 2019
LCO No. 5482
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT PROHIBITING HEALTH CARRIERS FROM REQUIR ING THE
USE OF STEP THERAPY FOR DRUGS PRESCRIBED TO TREAT
DISABLING, CHRONIC OR LIFE-THREATENING DISEASES OR
CONDITIONS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Subsection (a) of section 38a-510 of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective 2
January 1, 2020): 3
(a) No insurance company, hospital service corporation, medical 4
service corporation, health care center or other entity delivering, 5
issuing for delivery, renewing, amending or continuing an individual 6
health insurance policy or contract that provides coverage for 7
prescription drugs may: 8
(1) Require any person covered under such policy or contract to 9
obtain prescription drugs from a mail order pharmacy as a condition 10
of obtaining benefits for such drugs; or 11
(2) Require, if such insurance company, hospital service corporation, 12
medical service corporation, health care center or other entity uses step 13
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therapy for such drugs, the use of step therapy for: 14
(A) [any] Any prescribed drug for longer than sixty days; [,] or 15
(B) [a] A prescribed drug for [cancer] treatment of a disabling, 16
chronic or life-threatening disease or condition for an insured who has 17
been diagnosed with [stage IV metastatic cancer] such a disease or 18
condition, provided such prescribed drug is in compliance with 19
approved federal Food and Drug Administration indications. 20
(3) At the expiration of the time period specified in subparagraph 21
(A) of subdivision (2) of this subsection, [or for a prescribed drug 22
described in subparagraph (B) of subdivision (2) of this subsection,] an 23
insured's treating health care provider may deem such step therapy 24
drug regimen clinically ineffective for the insured, at which time the 25
insurance company, hospital service corporation, medical service 26
corporation, health care center or other entity shall authorize 27
dispensation of and coverage for the drug prescribed by the insured's 28
treating health care provider, provided such drug is a covered drug 29
under such policy or contract. If such provider does not deem such 30
step therapy drug regimen clinically ineffective or has not requested 31
an override pursuant to subdivision (1) of subsection (b) of this section, 32
such drug regimen may be continued. For purposes of this section, 33
"step therapy" means a protocol or program that establishes the 34
specific sequence in which prescription drugs for a specified medical 35
condition are to be prescribed. 36
Sec. 2. Subsection (a) of section 38a-544 of the general statutes is 37
repealed and the following is substituted in lieu thereof (Effective 38
January 1, 2020): 39
(a) No insurance company, hospital service corporation, medical 40
service corporation, health care center or other entity delivering, 41
issuing for delivery, renewing, amending or continuing a group health 42
insurance policy or contract that provides coverage for prescription 43
drugs may: 44
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(1) Require any person covered under such policy or contract to 45
obtain prescription drugs from a mail order pharmacy as a condition 46
of obtaining benefits for such drugs; or 47
(2) Require, if such insurance company, hospital service corporation, 48
medical service corporation, health care center or other entity uses step 49
therapy for such drugs, the use of step therapy for: 50
(A) [any] Any prescribed drug for longer than sixty days; [,] or 51
(B) [a] A prescribed drug for [cancer] treatment of a disabling, 52
chronic or life-threatening disease or condition for an insured who has 53
been diagnosed with [stage IV metastatic cancer] such a disease or 54
condition, provided such prescribed drug is in compliance with 55
approved federal Food and Drug Administration indications. 56
(3) At the expiration of the time period specified in subparagraph 57
(A) of subdivision (2) of this subsection, [or for a prescribed drug 58
described in subparagraph (B) of subdivision (2) of this subsection,] an 59
insured's treating health care provider may deem such step therapy 60
drug regimen clinically ineffective for the insured, at which time the 61
insurance company, hospital service corporation, medical service 62
corporation, health care center or other entity shall authorize 63
dispensation of and coverage for the drug prescribed by the insured's 64
treating health care provider, provided such drug is a covered drug 65
under such policy or contract. If such provider does not deem such 66
step therapy drug regimen clinically ineffective or has not requested 67
an override pursuant to subdivision (1) of subsection (b) of this section, 68
such drug regimen may be continued. For purposes of this section, 69
"step therapy" means a protocol or program that establishes the 70
specific sequence in which prescription drugs for a specified medical 71
condition are to be prescribed. 72
This act shall take effect as follows and shall amend the following
sections:
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Section 1 January 1, 2020 38a-510(a)
Sec. 2 January 1, 2020 38a-544(a)
Statement of Purpose:
To prohibit health carriers from requiring the use of step therapy for
drugs prescribed to treat disabling, chronic or life-threatening diseases
or conditions.
[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.]
Co-Sponsors: SEN. LOONEY, 11th Dist.
S.B. 36