Researcher: JKL Page 1 6/5/21
OLR Bill Analysis
sHB 6587 (as amended by House "A")*
AN ACT REQUIRING HEALTH INSURANCE COVERAGE FOR
EPINEPHRINE CARTRIDGE INJECTORS.
SUMMARY
This bill (1) requires certain health insurance policies that cover
outpatient prescription drugs to cover at least one epinephrine
cartridge injector (e.g., EpiPen) and (2) limits an insured’s cost sharing
(e.g., copayment, coinsurance, or deductible) for the injector to no
more than $25. (See below for the applicability of these provisions.)
By law, “epinephrine cartridge injector” means an automatic
prefilled cartridge injector or similar automatic injectable equipment
used to deliver epinephrine in a standard dose for an emergency first
aid response to allergic reactions.
Under the bill, each contract between a health carrier (e.g., insurer
or HMO) and a pharmacy benefits manager (PBM) that requires the
PBM to administer a health care plan’s pharmacy benefits on the
carrier’s behalf must also require the PBM, if it uses a tiered
prescription drug formulary (i.e., list of covered drugs), to include at
least one covered epinephrine cartridge injector in the lowest cost-
sharing tier.
Lastly, the bill requires the Office of Health Strategy (OHS), at least
annually, to conduct a study to determine the impact the bill’s
requirements have on the cost of affected health insurance policies,
including qualified health plans offered on the exchange (i.e., Access
Health CT). Beginning by January 31, 2023, OHS must annually report
its findings to the insurance commissioner and the Insurance and Real
Estate Committee.
*House Amendment “A” (1) specifies that affected insurance
policies must cover at least one epinephrine cartridge injector and (2) 2021HB-06587-R01-BA.DOCX
Researcher: JKL Page 2 6/5/21
adds the PBM formulary and OHS provisions.
EFFECTIVE DATE: January 1, 2022
APPLICABILITY OF INSURANCE COVERAGE REQUIREMENT
The bill applies to individual and group health insurance policies
delivered, issued, renewed, amended, or continued in Connecticut on
or after January 1, 2022, that cover (1) basic hospital expenses; (2) basic
medical-surgical expenses; (3) major medical expenses; (4) hospital or
medical services, including those provided under an HMO plan; or (5)
single service ancillary coverage, including prescription drug
coverage. Because of the federal Employee Retirement Income Security
Act (ERISA), state insurance benefit mandates do not apply to self-
insured benefit plans.
APPLICABILITY OF COST-SHARING PROVISION
The bill’s cost-sharing provision applies to each plan described
above. However, for plans that are high deductible health plans
(HDHPs), it only applies to the maximum extent (1) permitted by
federal law and (2) that does not disqualify someone who establishes a
health savings account (HSA), medical savings account (MSA), or
Archer MSA from receiving the associated federal tax benefits. Under
federal law, individuals with eligible HDHPs may make pre-tax
contributions to an HSA, MSA, or Archer MSA and use the account for
qualified medical expenses.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable Substitute
Yea 18 Nay 0 (03/22/2021)