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OLR Bill Analysis
HB 6622 (as amended by House "A")*
AN ACT CONCERNING PRESCRIPTION DRUG FORMULARIES
AND LISTS OF COVERED DRUGS.
SUMMARY
Beginning January 1, 2022, this bill prohibits health carriers (e.g.,
insurers and HMOs) offering a health benefit plan that covers
prescription drugs and uses a formulary (i.e., a list of covered
prescription drugs) from removing from the formulary or moving to a
higher cost-sharing tier, any covered drug during the plan year except
as specifically allowed (see below). This applies regardless of any other
general statute provision (see BACKGROUND).
Additionally, the bill requires the Office of Health Strategy (OHS),
at least annually, to conduct a study to determine the financial impact
of the bill’s requirements on the cost of commercial health plans in the
state, including those offered and sold on the exchange (i.e., Access
Health CT). Beginning by January 31, 2023, and annually thereafter,
OHS must report the study results for the preceding year to the
insurance commissioner and the Insurance and Real Estate Committee.
*House Amendment “A” adds the OHS study and reporting
provisions.
EFFECTIVE DATE: January 1, 2022
PERMITTED FORMULARY CHANGES
Under the bill, a health carrier may remove a prescription drug from
a formulary with at least 90 days’ advance notice to a covered person
and his or her treating physician if the U.S. Food and Drug
Administration (FDA):
1. issues an announcement, guidance, or similar statement
questioning the drug’s clinical safety, unless the treating 2021HB-06622-R01-BA.DOCX
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physician states in writing that the drug remains medically
necessary for the covered person, or
2. approves the drug for over-the-counter use.
The bill allows a carrier to move a drug to a higher cost-sharing tier
if it is available in-network for $40 or less per month in any tier. It also
allows a carrier to move a brand name drug to a higher cost-sharing
tier if it adds an FDA-approved generic alternative to the formulary at
a lower cost-sharing tier than the brand name drug.
Lastly, the bill specifies that it does not prevent or prohibit a carrier
from adding a prescription drug to a formulary at any time.
APPLICABILITY OF THE BILL’S PROVISIONS
The bill generally applies to each insurer, HMO, hospital or medical
service corporation, fraternal benefit society, or other entity that
delivers, issues, renews, amends, or continues individual or group
health insurance policies in Connecticut on or after January 1, 2022,
that cover (1) basic hospital expenses, (2) basic medical-surgical
expenses, (3) major medical expenses, or (4) hospital or medical
services. However, it does not apply to a grandfathered health plan,
which is a plan that existed on March 23, 2010, and has not made
significant coverage changes since.
Because of the federal Employee Retirement Income Security Act
(ERISA), state insurance benefit mandates do not apply to self-insured
benefit plans.
BACKGROUND
Related Law
The law prohibits health carriers that cover outpatient prescription
drugs from denying coverage for any drug removed from a formulary
if (1) an insured person was using the drug to treat a chronic illness
and had been covered for it before the removal and (2) his or her
attending physician states in writing, after the removal, that the drug is
medically necessary and why it is more beneficial than other formulary
drugs (CGS §§ 38a-492f & 38a-518f). 2021HB-06622-R01-BA.DOCX
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COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea 18 Nay 0 (03/22/2021)