OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
HB-5275
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM
REQUIRING STEP THERAPY FOR PRESCRIPTION DRUGS USED
TO TREAT MENTAL OR BEHAVIORAL HEALTH CONDITIONS.
Primary Analyst: RJW 4/4/22
Contributing Analyst(s): AS
Reviewer: AS
OFA Fiscal Note
State Impact: None
Municipal Impact:
Municipalities Effect FY 23 $ FY 24 $
Various Municipalities STATE
MANDATE
1
- Cost
See Below See Below
Explanation
The bill prohibits individual and group health insurance policies
from requiring the use of step therapy for drugs prescribed to treat
behavioral health conditions. This does not result in a fiscal impact to
the state employee and retiree health plan or municipalities that
participate in the Partnership Plan as step therapy is not required by the
plans.
These provisions will increase costs to certain fully insured municipal
plans which currently require step therapy for conditions specified in
the bill. The coverage requirements will result in increased premium
costs when municipalities enter new health insurance contracts after
January 1, 2023.
1
State mandate is defined in Sec. 2-32b(2) of the Connecticut General Statutes, "state
mandate" means any state initiated constitutional, statutory or executive action that
requires a local government to establish, expand or modify its activities in such a way
as to necessitate additional expenditures from local revenues. 2022HB-05275-R000294-FN.DOCX Page 2 of 2
In addition, many municipal health plans are recognized as
“grandfathered” health plans under the Affordable Care Act (ACA). It
is unclear what effect the adoption of certain health mandates will have
on the grandfathered status of certain municipal plans under ACA.
Pursuant to federal law, municipalities with self-insured plans are
exempt from state insurance mandates.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to inflation.