Researcher: JKL Page 1 4/29/21
OLR Bill Analysis
SB 1003 (File 363, as amended by Senate "A")*
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 discounts provided and payments made 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.
*Senate Amendment “A” adds explicit reference to discounts
provided by third parties.
EFFECTIVE DATE: January 1, 2022
COMMITTEE ACTION
Insurance and Real Estate Committee 2021SB-01003-R01-BA.DOCX
Researcher: JKL Page 2 4/29/21
Joint Favorable
Yea 18 Nay 0 (03/22/2021)