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PA 21-14—SB 1003
Insurance and Real Estate Committee
AN ACT PROHIBITING C ERTAIN HEALTH CARRIE RS AND
PHARMACY BENEFITS MA NAGERS FROM EMPLOYIN G COPAY
ACCUMULATOR PROGRAMS
SUMMARY: This act requires certain health carriers and pharmacy benefits
managers, when calculating a covered individual’s cost sharing liability (e.g.,
coinsurance, copayment, or deductible) for a covered benefit, to credit discounts
provided and payments made by a third party for any portion of the cost sharing.
Thus, it 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 act 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