Researcher: JKL Page 1 4/8/21
OLR Bill Analysis
SB 1003
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS AND
PHARMACY BENEFITS MANAGERS FROM EMPLOYING COPAY
ACCUMULATOR PROGRAMS.
SUMMARY
This bill requires certain health carriers and pharmacy benefits
managers, when calculating a covered individual’s cost sharing
liability (e.g., coinsurance, copayment, deductible) for a covered
benefit, to credit payments by a third party for any portion of the cost
sharing. Thus, the bill prohibits copay accumulator programs, under
which drug manufacturer coupons and copay assistance generally do
not apply toward a covered individual’s cost-sharing responsibility.
The bill applies to each insurer, hospital or medical service
corporation, HMO, or fraternal benefit society that delivers, issues,
renews, amends, or continues in Connecticut on or after January 1,
2022, individual or group health insurance policies that cover (1) basic
hospital expenses; (2) basic medical-surgical expenses; (3) major
medical expenses; or (4) hospital or medical services, including those
provided under an HMO plan. It also applies to managed care
organizations that deliver, issue, renew, amend, or continue contracts
in Connecticut on or after January 1, 2022, and pharmacy benefit
managers entering into contracts with health carriers on or after that
date.
EFFECTIVE DATE: January 1, 2022
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable
Yea 18 Nay 0 (03/22/2021)