Connecticut 2019 Regular Session

Connecticut Senate Bill SB00036 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
	3	+	LCO No. 919 1 of 1
3	4
4		-	LCO No. 5482 1 of 4
5		-
6		-	General Assembly Committee Bill No. 36
	5	+	General Assembly Proposed Bill No. 36
7	6		January Session, 2019
8		-	LCO No. ~~5482~~
	7	+	LCO No. 919
9	8
10	9
11	10		Referred to Committee on INSURANCE AND REAL ESTATE
12	11
13	12
14	13		Introduced by:
15		-	~~(INS)~~
	14	+	SEN. LOONEY, 11th Dist.
16	15
17	16
18	17
19	18		AN ACT PROHIBITING HEALTH CARRIERS FROM REQUIRING THE
20		-	USE OF STEP THERAPY FOR DRUGS PRESCRIBED TO TREAT
21		-	DISABLING, CHRONIC OR LIFE-THREATENING DISEASES OR
22		-	CONDITIONS.
	19	+	USE OF STEP THERAPY FOR CERTAIN PRESCRIPTION DRUGS.
23	20		Be it enacted by the Senate and House of Representatives in General
24	21		Assembly convened:
25	22
26		-	Section 1. Subsection (a) of section 38a-510 of the general statutes is 1
27		-	repealed and the following is substituted in lieu thereof (Effective 2
28		-	January 1, 2020): 3
29		-	(a) No insurance company, hospital service corporation, medical 4
30		-	service corporation, health care center or other entity delivering, 5
31		-	issuing for delivery, renewing, amending or continuing an individual 6
32		-	health insurance policy or contract that provides coverage for 7
33		-	prescription drugs may: 8
34		-	(1) Require any person covered under such policy or contract to 9
35		-	obtain prescription drugs from a mail order pharmacy as a condition 10
36		-	of obtaining benefits for such drugs; or 11
37		-	(2) Require, if such insurance company, hospital service corporation, 12
38		-	medical service corporation, health care center or other entity uses step 13
39		-	Committee Bill No. 36
40		-
41		-
42		-	LCO No. 5482 2 of 4
43		-
44		-	therapy for such drugs, the use of step therapy for: 14
45		-	(A) [any] Any prescribed drug for longer than sixty days; [,] or 15
46		-	(B) [a] A prescribed drug for [cancer] treatment of a disabling, 16
47		-	chronic or life-threatening disease or condition for an insured who has 17
48		-	been diagnosed with [stage IV metastatic cancer] such a disease or 18
49		-	condition, provided such prescribed drug is in compliance with 19
50		-	approved federal Food and Drug Administration indications. 20
51		-	(3) At the expiration of the time period specified in subparagraph 21
52		-	(A) of subdivision (2) of this subsection, [or for a prescribed drug 22
53		-	described in subparagraph (B) of subdivision (2) of this subsection,] an 23
54		-	insured's treating health care provider may deem such step therapy 24
55		-	drug regimen clinically ineffective for the insured, at which time the 25
56		-	insurance company, hospital service corporation, medical service 26
57		-	corporation, health care center or other entity shall authorize 27
58		-	dispensation of and coverage for the drug prescribed by the insured's 28
59		-	treating health care provider, provided such drug is a covered drug 29
60		-	under such policy or contract. If such provider does not deem such 30
61		-	step therapy drug regimen clinically ineffective or has not requested 31
62		-	an override pursuant to subdivision (1) of subsection (b) of this section, 32
63		-	such drug regimen may be continued. For purposes of this section, 33
64		-	"step therapy" means a protocol or program that establishes the 34
65		-	specific sequence in which prescription drugs for a specified medical 35
66		-	condition are to be prescribed. 36
67		-	Sec. 2. Subsection (a) of section 38a-544 of the general statutes is 37
68		-	repealed and the following is substituted in lieu thereof (Effective 38
69		-	January 1, 2020): 39
70		-	(a) No insurance company, hospital service corporation, medical 40
71		-	service corporation, health care center or other entity delivering, 41
72		-	issuing for delivery, renewing, amending or continuing a group health 42
73		-	insurance policy or contract that provides coverage for prescription 43
74		-	drugs may: 44
75		-	Committee Bill No. 36
76		-
77		-
78		-	LCO No. 5482 3 of 4
79		-
80		-	(1) Require any person covered under such policy or contract to 45
81		-	obtain prescription drugs from a mail order pharmacy as a condition 46
82		-	of obtaining benefits for such drugs; or 47
83		-	(2) Require, if such insurance company, hospital service corporation, 48
84		-	medical service corporation, health care center or other entity uses step 49
85		-	therapy for such drugs, the use of step therapy for: 50
86		-	(A) [any] Any prescribed drug for longer than sixty days; [,] or 51
87		-	(B) [a] A prescribed drug for [cancer] treatment of a disabling, 52
88		-	chronic or life-threatening disease or condition for an insured who has 53
89		-	been diagnosed with [stage IV metastatic cancer] such a disease or 54
90		-	condition, provided such prescribed drug is in compliance with 55
91		-	approved federal Food and Drug Administration indications. 56
92		-	(3) At the expiration of the time period specified in subparagraph 57
93		-	(A) of subdivision (2) of this subsection, [or for a prescribed drug 58
94		-	described in subparagraph (B) of subdivision (2) of this subsection,] an 59
95		-	insured's treating health care provider may deem such step therapy 60
96		-	drug regimen clinically ineffective for the insured, at which time the 61
97		-	insurance company, hospital service corporation, medical service 62
98		-	corporation, health care center or other entity shall authorize 63
99		-	dispensation of and coverage for the drug prescribed by the insured's 64
100		-	treating health care provider, provided such drug is a covered drug 65
101		-	under such policy or contract. If such provider does not deem such 66
102		-	step therapy drug regimen clinically ineffective or has not requested 67
103		-	an override pursuant to subdivision (1) of subsection (b) of this section, 68
104		-	such drug regimen may be continued. For purposes of this section, 69
105		-	"step therapy" means a protocol or program that establishes the 70
106		-	specific sequence in which prescription drugs for a specified medical 71
107		-	condition are to be prescribed. 72
108		-	This act shall take effect as follows and shall amend the following
109		-	sections:
110		-
111		-	Committee Bill No. 36
112		-
113		-
114		-	LCO No. 5482 4 of 4
115		-
116		-	Section 1 January 1, 2020 38a-510(a)
117		-	Sec. 2 January 1, 2020 38a-544(a)
118		-
	23	+	That sections 38a-510 and 38a-544 of the general statutes be 1
	24	+	amended to prohibit health carriers that deliver, issue for delivery, 2
	25	+	renew, amend or continue health insurance policies and contracts in 3
	26	+	this state that provide coverage for prescription drugs from requiring 4
	27	+	the use of step therapy for a prescription drug if such drug is 5
	28	+	prescribed for the treatment of a disabling, chronic or life-threatening 6
	29	+	disease or condition. 7
119	30		Statement of Purpose:
120		-	To prohibit health carriers from requiring the use of step therapy for
121		-	drugs prescribed to treat disabling, chronic or life-threatening diseases
122		-	or conditions.
123		-	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline,
124		-	except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is
125		-	not underlined.]
126		-
127		-	Co-Sponsors: SEN. LOONEY, 11th Dist.
128		-
129		-	S.B. 36
130		-
131		-
	31	+	To prohibit health carriers that deliver, issue for delivery, renew,
	32	+	amend or continue certain health insurance policies and contracts in
	33	+	this state from requiring the use of step therapy for a prescription drug
	34	+	if such drug is prescribed for the treatment of a disabling, chronic or
	35	+	life-threatening disease or condition.