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General Assembly Raised Bill No. 6622
January Session, 2021
LCO No. 3861
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING PR ESCRIPTION DRUG FORM ULARIES AND
LISTS OF COVERED DRU GS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-1 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2022): 2
Terms used in this title and section 2 of this act, unless it appears from 3
the context to the contrary, shall have a scope and meaning as set forth 4
in this section. 5
(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
through one or more intermediaries, controls, is controlled by or is 7
under common control with another person. 8
(2) "Alien insurer" means any insurer that has been chartered by or 9
organized or constituted within or under the laws of any jurisdiction or 10
country without the United States. 11
(3) "Annuities" means all agreements to make periodical payments 12
where the making or continuance of all or some of the series of the 13 Raised Bill No. 6622
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payments, or the amount of the payment, is dependent upon the 14
continuance of human life or is for a specified term of years. This 15
definition does not apply to payments made under a policy of life 16
insurance. 17
(4) "Commissioner" means the Insurance Commissioner. 18
(5) "Control", "controlled by" or "under common control with" means 19
the possession, direct or indirect, of the power to direct or cause the 20
direction of the management and policies of a person, whether through 21
the ownership of voting securities, by contract other than a commercial 22
contract for goods or nonmanagement services, or otherwise, unless the 23
power is the result of an official position with the person. 24
(6) "Domestic insurer" means any insurer that has been chartered by, 25
incorporated, organized or constituted within or under the laws of this 26
state. 27
(7) "Domestic surplus lines insurer" means any domestic insurer that 28
has been authorized by the commissioner to write surplus lines 29
insurance. 30
(8) "Foreign country" means any jurisdiction not in any state, district 31
or territory of the United States. 32
(9) "Foreign insurer" means any insurer that has been chartered by or 33
organized or constituted within or under the laws of another state or a 34
territory of the United States. 35
(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
unable to pay its obligations when they are due, or when its admitted 37
assets do not exceed its liabilities plus the greater of: (A) Capital and 38
surplus required by law for its organization and continued operation; 39
or (B) the total par or stated value of its authorized and issued capital 40
stock. For purposes of this subdivision "liabilities" shall include but not 41
be limited to reserves required by statute or by regulations adopted by 42
the commissioner in accordance with the provisions of chapter 54 or 43 Raised Bill No. 6622
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specific requirements imposed by the commissioner upon a subject 44
company at the time of admission or subsequent thereto. 45
(11) "Insurance" means any agreement to pay a sum of money, 46
provide services or any other thing of value on the happening of a 47
particular event or contingency or to provide indemnity for loss in 48
respect to a specified subject by specified perils in return for a 49
consideration. In any contract of insurance, an insured shall have an 50
interest which is subject to a risk of loss through destruction or 51
impairment of that interest, which risk is assumed by the insurer and 52
such assumption shall be part of a general scheme to distribute losses 53
among a large group of persons bearing similar risks in return for a 54
ratable contribution or other consideration. 55
(12) "Insurer" or "insurance company" includes any person or 56
combination of persons doing any kind or form of insurance business 57
other than a fraternal benefit society, and shall include a receiver of any 58
insurer when the context reasonably permits. 59
(13) "Insured" means a person to whom or for whose benefit an 60
insurer makes a promise in an insurance policy. The term includes 61
policyholders, subscribers, members and beneficiaries. This definition 62
applies only to the provisions of this title and does not define the 63
meaning of this word as used in insurance policies or certificates. 64
(14) "Life insurance" means insurance on human lives and insurances 65
pertaining to or connected with human life. The business of life 66
insurance includes granting endowment benefits, granting additional 67
benefits in the event of death by accident or accidental means, granting 68
additional benefits in the event of the total and permanent disability of 69
the insured, and providing optional methods of settlement of proceeds. 70
Life insurance includes burial contracts to the extent provided by 71
section 38a-464. 72
(15) "Mutual insurer" means any insurer without capital stock, the 73
managing directors or officers of which are elected by its members. 74 Raised Bill No. 6622
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(16) "Person" means an individual, a corporation, a partnership, a 75
limited liability company, an association, a joint stock company, a 76
business trust, an unincorporated organization or other legal entity. 77
(17) "Policy" means any document, including attached endorsements 78
and riders, purporting to be an enforceable contract, which 79
memorializes in writing some or all of the terms of an insurance 80
contract. 81
(18) "State" means any state, district, or territory of the United States. 82
(19) "Subsidiary" of a specified person means an affiliate controlled 83
by the person directly, or indirectly through one or more intermediaries. 84
(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
insurer that has not been granted a certificate of authority by the 86
commissioner to transact the business of insurance in this state or an 87
insurer transacting business not authorized by a valid certificate. 88
(21) "United States" means the United States of America, its territories 89
and possessions, the Commonwealth of Puerto Rico and the District of 90
Columbia. 91
Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this 92
section: 93
(1) "Affordable Care Act" has the same meaning as provided in 94
section 38a-1080 of the general statutes; 95
(2) "Health benefit plan" has the same meaning as provided in section 96
38a-1080 of the general statutes, except that such term shall not include 97
a grandfathered health plan as such term is used in the Affordable Care 98
Act; and 99
(3) "Health carrier" has the same meaning as provided in section 38a-100
1080 of the general statutes. 101
(b) Notwithstanding any provision of the general statutes and except 102 Raised Bill No. 6622
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as provided in subsection (c) of this section, no health carrier offering a 103
health benefit plan in this state on or after January 1, 2022, that includes 104
a pharmacy benefit and uses a drug formulary or list of covered drugs 105
may: 106
(1) Remove a prescription drug from the drug formulary or list of 107
covered drugs during a plan year; or 108
(2) Move a prescription drug from a cost-sharing tier that imposes a 109
lesser coinsurance, copayment or deductible for the prescription drug to 110
a cost-sharing tier that imposes a greater coinsurance, copayment or 111
deductible for the prescription drug during a plan year, unless the 112
prescription drug is subject to an in-network coinsurance, copayment or 113
deductible that is not greater than forty dollars per prescription per 114
month in any tier. 115
(c) A health carrier offering a health benefit plan in this state on or 116
after January 1, 2022, that includes a pharmacy benefit and uses a drug 117
formulary or list of covered drugs may: 118
(1) Remove a prescription drug from the drug formulary or list of 119
covered drugs, upon at least ninety days' advance notice to a covered 120
person and the covered person's treating physician, if: 121
(A) The federal Food and Drug Administration issues an 122
announcement, guidance, notice, warning or statement concerning the 123
prescription drug that calls into question the clinical safety of the 124
prescription drug, unless the covered person's treating physician states, 125
in writing, that the prescription drug remains medically necessary 126
despite such announcement, guidance, notice, warning or statement; or 127
(B) The prescription drug is approved by the federal Food and Drug 128
Administration for use without a prescription; and 129
(2) Move a brand-name prescription drug from a cost-sharing tier 130
that imposes a lesser coinsurance, copayment or deductible for the 131
brand-name prescription drug to a cost-sharing tier that imposes a 132 Raised Bill No. 6622
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greater coinsurance, copayment or deductible for the brand-name 133
prescription drug if the health carrier adds to the drug formulary or list 134
of covered drugs a generic prescription drug that is: 135
(A) Approved by the federal Food and Drug Administration for use 136
as an alternative to such brand-name prescription drug; and 137
(B) In a cost-sharing tier that imposes a coinsurance, copayment or 138
deductible for the generic prescription drug that is lesser than the 139
coinsurance, copayment or deductible that is imposed for such brand-140
name prescription drug. 141
(d) Nothing in this section shall prevent or prohibit a health carrier 142
from adding a prescription drug to a formulary or list of covered drugs 143
at any time. 144
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2022 38a-1
Sec. 2 January 1, 2022 New section
Statement of Purpose:
To limit the circumstances in which a health carrier may remove a
prescription drug from a drug formulary or list of covered drugs, or
move a prescription drug to a different cost-sharing tier, during a plan
year.
[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.]