Connecticut 2021 Regular Session

Connecticut House Bill HB06622 Compare Versions

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Version 2 (New)

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	7	+	General Assembly Raised Bill No. 6622
	8	+	January Session, 2021
	9	+	LCO No. 3861
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	11	+
	12	+	Referred to Committee on INSURANCE AND REAL ESTATE
	13	+
	14	+
	15	+	Introduced by:
	16	+	(INS)
1	17
2	18
3	19
4		-	House Bill No. 6622
5		-
6		-	Public Act No. 21-96
7		-
8		-
9		-	AN ACT CONCERNING PRESCRIPTION DRUG FORMULARIES
10		-	AND LISTS OF COVERED DRUGS.
	20	+	AN ACT CONCERNING PR ESCRIPTION DRUG FORMULARIES AND
	21	+	LISTS OF COVERED DRU GS.
11	22		Be it enacted by the Senate and House of Representatives in General
12	23		Assembly convened:
13	24
14		-	Section 1. Section 38a-1 of the general statutes is repealed and the
15		-	following is substituted in lieu thereof (Effective January 1, 2022):
16		-	Terms used in this title and section 2 of this act, unless it appears from
17		-	the context to the contrary, shall have a scope and meaning as set forth
18		-	in this section.
19		-	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly
20		-	through one or more intermediaries, controls, is controlled by or is
21		-	under common control with another person.
22		-	(2) "Alien insurer" means any insurer that has been chartered by or
23		-	organized or constituted within or under the laws of any jurisdiction or
24		-	country without the United States.
25		-	(3) "Annuities" means all agreements to make periodical payments
26		-	where the making or continuance of all or some of the series of the
27		-	payments, or the amount of the payment, is dependent upon the
28		-	continuance of human life or is for a specified term of years. This
29		-	definition does not apply to payments made under a policy of life House Bill No. 6622
	25	+	Section 1. Section 38a-1 of the general statutes is repealed and the 1
	26	+	following is substituted in lieu thereof (Effective January 1, 2022): 2
	27	+	Terms used in this title and section 2 of this act, unless it appears from 3
	28	+	the context to the contrary, shall have a scope and meaning as set forth 4
	29	+	in this section. 5
	30	+	(1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6
	31	+	through one or more intermediaries, controls, is controlled by or is 7
	32	+	under common control with another person. 8
	33	+	(2) "Alien insurer" means any insurer that has been chartered by or 9
	34	+	organized or constituted within or under the laws of any jurisdiction or 10
	35	+	country without the United States. 11
	36	+	(3) "Annuities" means all agreements to make periodical payments 12
	37	+	where the making or continuance of all or some of the series of the 13 Raised Bill No. 6622
30	38
31		-	Public Act No. 21-96 2 of 7
32	39
33		-	insurance.
34		-	(4) "Commissioner" means the Insurance Commissioner.
35		-	(5) "Control", "controlled by" or "under common control with" means
36		-	the possession, direct or indirect, of the power to direct or cause the
37		-	direction of the management and policies of a person, whether through
38		-	the ownership of voting securities, by contract other than a commercial
39		-	contract for goods or nonmanagement services, or otherwise, unless the
40		-	power is the result of an official position with the person.
41		-	(6) "Domestic insurer" means any insurer that has been chartered by,
42		-	incorporated, organized or constituted within or under the laws of this
43		-	state.
44		-	(7) "Domestic surplus lines insurer" means any domestic insurer that
45		-	has been authorized by the commissioner to write surplus lines
46		-	insurance.
47		-	(8) "Foreign country" means any jurisdiction not in any state, district
48		-	or territory of the United States.
49		-	(9) "Foreign insurer" means any insurer that has been chartered by or
50		-	organized or constituted within or under the laws of another state or a
51		-	territory of the United States.
52		-	(10) "Insolvency" or "insolvent" means, for any insurer, that it is
53		-	unable to pay its obligations when they are due, or when its admitted
54		-	assets do not exceed its liabilities plus the greater of: (A) Capital and
55		-	surplus required by law for its organization and continued operation;
56		-	or (B) the total par or stated value of its authorized and issued capital
57		-	stock. For purposes of this subdivision "liabilities" shall include but not
58		-	be limited to reserves required by statute or by regulations adopted by
59		-	the commissioner in accordance with the provisions of chapter 54 or
60		-	specific requirements imposed by the commissioner upon a subject House Bill No. 6622
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61	43
62		-	Public Act No. 21-96 3 of 7
	44	+	payments, or the amount of the payment, is dependent upon the 14
	45	+	continuance of human life or is for a specified term of years. This 15
	46	+	definition does not apply to payments made under a policy of life 16
	47	+	insurance. 17
	48	+	(4) "Commissioner" means the Insurance Commissioner. 18
	49	+	(5) "Control", "controlled by" or "under common control with" means 19
	50	+	the possession, direct or indirect, of the power to direct or cause the 20
	51	+	direction of the management and policies of a person, whether through 21
	52	+	the ownership of voting securities, by contract other than a commercial 22
	53	+	contract for goods or nonmanagement services, or otherwise, unless the 23
	54	+	power is the result of an official position with the person. 24
	55	+	(6) "Domestic insurer" means any insurer that has been chartered by, 25
	56	+	incorporated, organized or constituted within or under the laws of this 26
	57	+	state. 27
	58	+	(7) "Domestic surplus lines insurer" means any domestic insurer that 28
	59	+	has been authorized by the commissioner to write surplus lines 29
	60	+	insurance. 30
	61	+	(8) "Foreign country" means any jurisdiction not in any state, district 31
	62	+	or territory of the United States. 32
	63	+	(9) "Foreign insurer" means any insurer that has been chartered by or 33
	64	+	organized or constituted within or under the laws of another state or a 34
	65	+	territory of the United States. 35
	66	+	(10) "Insolvency" or "insolvent" means, for any insurer, that it is 36
	67	+	unable to pay its obligations when they are due, or when its admitted 37
	68	+	assets do not exceed its liabilities plus the greater of: (A) Capital and 38
	69	+	surplus required by law for its organization and continued operation; 39
	70	+	or (B) the total par or stated value of its authorized and issued capital 40
	71	+	stock. For purposes of this subdivision "liabilities" shall include but not 41
	72	+	be limited to reserves required by statute or by regulations adopted by 42
	73	+	the commissioner in accordance with the provisions of chapter 54 or 43 Raised Bill No. 6622
63	74
64		-	company at the time of admission or subsequent thereto.
65		-	(11) "Insurance" means any agreement to pay a sum of money,
66		-	provide services or any other thing of value on the happening of a
67		-	particular event or contingency or to provide indemnity for loss in
68		-	respect to a specified subject by specified perils in return for a
69		-	consideration. In any contract of insurance, an insured shall have an
70		-	interest which is subject to a risk of loss through destruction or
71		-	impairment of that interest, which risk is assumed by the insurer and
72		-	such assumption shall be part of a general scheme to distribute losses
73		-	among a large group of persons bearing similar risks in return for a
74		-	ratable contribution or other consideration.
75		-	(12) "Insurer" or "insurance company" includes any person or
76		-	combination of persons doing any kind or form of insurance business
77		-	other than a fraternal benefit society, and shall include a receiver of any
78		-	insurer when the context reasonably permits.
79		-	(13) "Insured" means a person to whom or for whose benefit an
80		-	insurer makes a promise in an insurance policy. The term includes
81		-	policyholders, subscribers, members and beneficiaries. This definition
82		-	applies only to the provisions of this title and does not define the
83		-	meaning of this word as used in insurance policies or certificates.
84		-	(14) "Life insurance" means insurance on human lives and insurances
85		-	pertaining to or connected with human life. The business of life
86		-	insurance includes granting endowment benefits, granting additional
87		-	benefits in the event of death by accident or accidental means, granting
88		-	additional benefits in the event of the total and permanent disability of
89		-	the insured, and providing optional methods of settlement of proceeds.
90		-	Life insurance includes burial contracts to the extent provided by
91		-	section 38a-464.
92		-	(15) "Mutual insurer" means any insurer without capital stock, the House Bill No. 6622
93	75
94		-	Public Act No. 21-96 4 of 7
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95	79
96		-	managing directors or officers of which are elected by its members.
97		-	(16) "Person" means an individual, a corporation, a partnership, a
98		-	limited liability company, an association, a joint stock company, a
99		-	business trust, an unincorporated organization or other legal entity.
100		-	(17) "Policy" means any document, including attached endorsements
101		-	and riders, purporting to be an enforceable contract, which
102		-	memorializes in writing some or all of the terms of an insurance
103		-	contract.
104		-	(18) "State" means any state, district, or territory of the United States.
105		-	(19) "Subsidiary" of a specified person means an affiliate controlled
106		-	by the person directly, or indirectly through one or more intermediaries.
107		-	(20) "Unauthorized insurer" or "nonadmitted insurer" means an
108		-	insurer that has not been granted a certificate of authority by the
109		-	commissioner to transact the business of insurance in this state or an
110		-	insurer transacting business not authorized by a valid certificate.
111		-	(21) "United States" means the United States of America, its territories
112		-	and possessions, the Commonwealth of Puerto Rico and the District of
113		-	Columbia.
114		-	Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this
115		-	section:
116		-	(1) "Affordable Care Act" has the same meaning as provided in
117		-	section 38a-1080 of the general statutes;
118		-	(2) "Exchange" has the same meaning as provided in section 38a-1080
119		-	of the general statutes;
120		-	(3) "Health benefit plan" has the same meaning as provided in section
121		-	38a-1080 of the general statutes, except that such term shall not include House Bill No. 6622
	80	+	specific requirements imposed by the commissioner upon a subject 44
	81	+	company at the time of admission or subsequent thereto. 45
	82	+	(11) "Insurance" means any agreement to pay a sum of money, 46
	83	+	provide services or any other thing of value on the happening of a 47
	84	+	particular event or contingency or to provide indemnity for loss in 48
	85	+	respect to a specified subject by specified perils in return for a 49
	86	+	consideration. In any contract of insurance, an insured shall have an 50
	87	+	interest which is subject to a risk of loss through destruction or 51
	88	+	impairment of that interest, which risk is assumed by the insurer and 52
	89	+	such assumption shall be part of a general scheme to distribute losses 53
	90	+	among a large group of persons bearing similar risks in return for a 54
	91	+	ratable contribution or other consideration. 55
	92	+	(12) "Insurer" or "insurance company" includes any person or 56
	93	+	combination of persons doing any kind or form of insurance business 57
	94	+	other than a fraternal benefit society, and shall include a receiver of any 58
	95	+	insurer when the context reasonably permits. 59
	96	+	(13) "Insured" means a person to whom or for whose benefit an 60
	97	+	insurer makes a promise in an insurance policy. The term includes 61
	98	+	policyholders, subscribers, members and beneficiaries. This definition 62
	99	+	applies only to the provisions of this title and does not define the 63
	100	+	meaning of this word as used in insurance policies or certificates. 64
	101	+	(14) "Life insurance" means insurance on human lives and insurances 65
	102	+	pertaining to or connected with human life. The business of life 66
	103	+	insurance includes granting endowment benefits, granting additional 67
	104	+	benefits in the event of death by accident or accidental means, granting 68
	105	+	additional benefits in the event of the total and permanent disability of 69
	106	+	the insured, and providing optional methods of settlement of proceeds. 70
	107	+	Life insurance includes burial contracts to the extent provided by 71
	108	+	section 38a-464. 72
	109	+	(15) "Mutual insurer" means any insurer without capital stock, the 73
	110	+	managing directors or officers of which are elected by its members. 74 Raised Bill No. 6622
122	111
123		-	Public Act No. 21-96 5 of 7
124	112
125		-	a grandfathered health plan as such term is used in the Affordable Care
126		-	Act;
127		-	(4) "Health carrier" has the same meaning as provided in section 38a-
128		-	1080 of the general statutes;
129		-	(5) "Office of Health Strategy" means the Office of Health Strategy
130		-	established under section 19a-754a of the general statutes; and
131		-	(6) "Qualified health plan" has the same meaning as provided in
132		-	section 38a-1080 of the general statutes.
133		-	(b) Notwithstanding any provision of the general statutes and except
134		-	as provided in subsection (c) of this section, no health carrier offering a
135		-	health benefit plan in this state on or after January 1, 2022, that includes
136		-	a pharmacy benefit and uses a drug formulary or list of covered drugs
137		-	may:
138		-	(1) Remove a prescription drug from the drug formulary or list of
139		-	covered drugs during a plan year; or
140		-	(2) Move a prescription drug from a cost-sharing tier that imposes a
141		-	lesser coinsurance, copayment or deductible for the prescription drug to
142		-	a cost-sharing tier that imposes a greater coinsurance, copayment or
143		-	deductible for the prescription drug during a plan year, unless the
144		-	prescription drug is subject to an in-network coinsurance, copayment or
145		-	deductible that is not greater than forty dollars per prescription per
146		-	month in any tier.
147		-	(c) A health carrier offering a health benefit plan in this state on or
148		-	after January 1, 2022, that includes a pharmacy benefit and uses a drug
149		-	formulary or list of covered drugs may:
150		-	(1) Remove a prescription drug from the drug formulary or list of
151		-	covered drugs, upon at least ninety days' advance notice to a covered House Bill No. 6622
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152	116
153		-	Public Act No. 21-96 6 of 7
	117	+	(16) "Person" means an individual, a corporation, a partnership, a 75
	118	+	limited liability company, an association, a joint stock company, a 76
	119	+	business trust, an unincorporated organization or other legal entity. 77
	120	+	(17) "Policy" means any document, including attached endorsements 78
	121	+	and riders, purporting to be an enforceable contract, which 79
	122	+	memorializes in writing some or all of the terms of an insurance 80
	123	+	contract. 81
	124	+	(18) "State" means any state, district, or territory of the United States. 82
	125	+	(19) "Subsidiary" of a specified person means an affiliate controlled 83
	126	+	by the person directly, or indirectly through one or more intermediaries. 84
	127	+	(20) "Unauthorized insurer" or "nonadmitted insurer" means an 85
	128	+	insurer that has not been granted a certificate of authority by the 86
	129	+	commissioner to transact the business of insurance in this state or an 87
	130	+	insurer transacting business not authorized by a valid certificate. 88
	131	+	(21) "United States" means the United States of America, its territories 89
	132	+	and possessions, the Commonwealth of Puerto Rico and the District of 90
	133	+	Columbia. 91
	134	+	Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this 92
	135	+	section: 93
	136	+	(1) "Affordable Care Act" has the same meaning as provided in 94
	137	+	section 38a-1080 of the general statutes; 95
	138	+	(2) "Health benefit plan" has the same meaning as provided in section 96
	139	+	38a-1080 of the general statutes, except that such term shall not include 97
	140	+	a grandfathered health plan as such term is used in the Affordable Care 98
	141	+	Act; and 99
	142	+	(3) "Health carrier" has the same meaning as provided in section 38a-100
	143	+	1080 of the general statutes. 101
	144	+	(b) Notwithstanding any provision of the general statutes and except 102 Raised Bill No. 6622
154	145
155		-	person and the covered person's treating physician, if:
156		-	(A) The federal Food and Drug Administration issues an
157		-	announcement, guidance, notice, warning or statement concerning the
158		-	prescription drug that calls into question the clinical safety of the
159		-	prescription drug, unless the covered person's treating physician states,
160		-	in writing, that the prescription drug remains medically necessary
161		-	despite such announcement, guidance, notice, warning or statement; or
162		-	(B) The prescription drug is approved by the federal Food and Drug
163		-	Administration for use without a prescription; and
164		-	(2) Move a brand-name prescription drug from a cost-sharing tier
165		-	that imposes a lesser coinsurance, copayment or deductible for the
166		-	brand-name prescription drug to a cost-sharing tier that imposes a
167		-	greater coinsurance, copayment or deductible for the brand-name
168		-	prescription drug if the health carrier adds to the drug formulary or list
169		-	of covered drugs a generic prescription drug that is:
170		-	(A) Approved by the federal Food and Drug Administration for use
171		-	as an alternative to such brand-name prescription drug; and
172		-	(B) In a cost-sharing tier that imposes a coinsurance, copayment or
173		-	deductible for the generic prescription drug that is lesser than the
174		-	coinsurance, copayment or deductible that is imposed for such brand-
175		-	name prescription drug.
176		-	(d) Nothing in this section shall prevent or prohibit a health carrier
177		-	from adding a prescription drug to a formulary or list of covered drugs
178		-	at any time.
179		-	(e) (1) The Office of Health Strategy shall, at least annually, conduct
180		-	a study to determine the impact that the requirements established in
181		-	subsections (a) to (d), inclusive, of this section have on the cost of health
182		-	benefit plans offered, delivered, issued for delivery, renewed, amended House Bill No. 6622
183	146
184		-	Public Act No. 21-96 7 of 7
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185	150
186		-	or continued in this state and qualified health plans offered and sold
187		-	through the exchange.
188		-	(2) Not later than January 31, 2023, and annually thereafter, the Office
189		-	of Health Strategy shall submit a report, in accordance with the
190		-	provisions of section 11-4a of the general statutes, to the commissioner
191		-	and the joint standing committee of the General Assembly having
192		-	cognizance of matters relating to insurance. Such report shall disclose
193		-	the results of the study conducted pursuant to subdivision (1) of this
194		-	subsection for the preceding year.
	151	+	as provided in subsection (c) of this section, no health carrier offering a 103
	152	+	health benefit plan in this state on or after January 1, 2022, that includes 104
	153	+	a pharmacy benefit and uses a drug formulary or list of covered drugs 105
	154	+	may: 106
	155	+	(1) Remove a prescription drug from the drug formulary or list of 107
	156	+	covered drugs during a plan year; or 108
	157	+	(2) Move a prescription drug from a cost-sharing tier that imposes a 109
	158	+	lesser coinsurance, copayment or deductible for the prescription drug to 110
	159	+	a cost-sharing tier that imposes a greater coinsurance, copayment or 111
	160	+	deductible for the prescription drug during a plan year, unless the 112
	161	+	prescription drug is subject to an in-network coinsurance, copayment or 113
	162	+	deductible that is not greater than forty dollars per prescription per 114
	163	+	month in any tier. 115
	164	+	(c) A health carrier offering a health benefit plan in this state on or 116
	165	+	after January 1, 2022, that includes a pharmacy benefit and uses a drug 117
	166	+	formulary or list of covered drugs may: 118
	167	+	(1) Remove a prescription drug from the drug formulary or list of 119
	168	+	covered drugs, upon at least ninety days' advance notice to a covered 120
	169	+	person and the covered person's treating physician, if: 121
	170	+	(A) The federal Food and Drug Administration issues an 122
	171	+	announcement, guidance, notice, warning or statement concerning the 123
	172	+	prescription drug that calls into question the clinical safety of the 124
	173	+	prescription drug, unless the covered person's treating physician states, 125
	174	+	in writing, that the prescription drug remains medically necessary 126
	175	+	despite such announcement, guidance, notice, warning or statement; or 127
	176	+	(B) The prescription drug is approved by the federal Food and Drug 128
	177	+	Administration for use without a prescription; and 129
	178	+	(2) Move a brand-name prescription drug from a cost-sharing tier 130
	179	+	that imposes a lesser coinsurance, copayment or deductible for the 131
	180	+	brand-name prescription drug to a cost-sharing tier that imposes a 132 Raised Bill No. 6622
	181	+
	182	+
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	186	+
	187	+	greater coinsurance, copayment or deductible for the brand-name 133
	188	+	prescription drug if the health carrier adds to the drug formulary or list 134
	189	+	of covered drugs a generic prescription drug that is: 135
	190	+	(A) Approved by the federal Food and Drug Administration for use 136
	191	+	as an alternative to such brand-name prescription drug; and 137
	192	+	(B) In a cost-sharing tier that imposes a coinsurance, copayment or 138
	193	+	deductible for the generic prescription drug that is lesser than the 139
	194	+	coinsurance, copayment or deductible that is imposed for such brand-140
	195	+	name prescription drug. 141
	196	+	(d) Nothing in this section shall prevent or prohibit a health carrier 142
	197	+	from adding a prescription drug to a formulary or list of covered drugs 143
	198	+	at any time. 144
	199	+	This act shall take effect as follows and shall amend the following
	200	+	sections:
	201	+
	202	+	Section 1 January 1, 2022 38a-1
	203	+	Sec. 2 January 1, 2022 New section
	204	+
	205	+	INS Joint Favorable
195	206