Connecticut House Bill HB05346

Connecticut 2021 Regular Session

• Introduced: 1/22/21
• Refer: 1/22/21

Caption

An Act Limiting Changes To Prescription Drug Formularies.

Impact

The bill introduces two primary conditions under which a health carrier may change a covered drug's status: either the drug is deemed not medically necessary, and only upon receiving agreement from the prescribing healthcare provider, or the drug is found to be unsafe and ineffective based on FDA guidelines or peer-reviewed medical literature. This regulatory change aims to protect consumers from abrupt increases in out-of-pocket costs associated with essential medications and to ensure continuity in medication management during the policy term.

Summary

House Bill 5346 proposes amendments to the existing statutes regarding prescription drug formularies within health insurance plans. The main objective of this bill is to prevent health carriers from removing or reclassifying covered prescription drugs during a policy term without substantial justification. Specifically, health carriers are limited in their power to alter the coverage status of drugs, which can significantly impact insured individuals and their healthcare providers.

Contention

Notable points of contention surrounding HB 5346 include the balance of power between health carriers and consumers. Proponents argue that it fortifies patient rights and ensures that essential medications remain accessible without disruptive changes during the year, thereby promoting better health outcomes. Conversely, opponents raise concerns about the potential for increased costs for health carriers, which could lead to higher premiums for policyholders. The debate highlights differing perspectives on how regulatory frameworks can best serve both the industry and consumers.