Connecticut 2022 Regular Session

Connecticut House Bill HB05386 Compare Versions

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7	7		General Assembly Substitute Bill No. 5386
8	8		February Session, 2022
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14	14		AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR
15	15		EPINEPHRINE CARTRIDGE INJECTORS, HEALTH CARRIERS AND
16	16		PHARMACY BENEFIT MANAGERS .
17	17		Be it enacted by the Senate and House of Representatives in General
18	18		Assembly convened:
19	19
20	20		Section 1. (NEW) (Effective January 1, 2023) (a) Each individual health 1
21	21		insurance policy providing coverage of the type specified in 2
22	22		subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 3
23	23		general statutes delivered, issued for delivery, renewed, amended or 4
24	24		continued in this state on or after January 1, 2023, that includes coverage 5
25	25		for outpatient prescription drugs shall provide coverage for at least one 6
26	26		epinephrine cartridge injector, as defined in section 19a-909 of the 7
27	27		general statutes. 8
28	28		(b) No policy described in subsection (a) of this section shall impose 9
29	29		a coinsurance, copayment, deductible or other out-of-pocket expense for 10
30	30		the epinephrine cartridge injector that such policy is required to cover 11
31	31		pursuant to said subsection (a) in an amount that is greater than twenty-12
32	32		five dollars. The provisions of this subsection shall apply to a high 13
33	33		deductible health plan, as that term is used in subsection (f) of section 14
34	34		38a-493 of the general statutes, to the maximum extent permitted by 15
35	35		federal law, except if such plan is used to establish a medical savings 16
36	36		account or an Archer MSA pursuant to Section 220 of the Internal 17 Substitute Bill No. 5386
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43	43		Revenue Code of 1986, or any subsequent corresponding internal 18
44	44		revenue code of the United States, as amended from time to time, or a 19
45	45		health savings account pursuant to Section 223 of said Internal Revenue 20
46	46		Code, as amended from time to time. The provisions of this subsection 21
47	47		shall apply to such high deductible health plans to the maximum extent 22
48	48		that (1) is permitted by federal law, and (2) does not disqualify such 23
49	49		account for the deduction allowed under Section 220 or 223, of the 24
50	50		Internal Revenue Code of 1986, as applicable. 25
51	51		Sec. 2. (NEW) (Effective January 1, 2023) (a) Each group health 26
52	52		insurance policy providing coverage of the type specified in 27
53	53		subdivisions (1), (2), (4), (11), (12) and (16) of section 38a-469 of the 28
54	54		general statutes delivered, issued for delivery, renewed, amended or 29
55	55		continued in this state on or after January 1, 2023, that includes coverage 30
56	56		for outpatient prescription drugs shall provide coverage for at least one 31
57	57		epinephrine cartridge injector, as defined in section 19a-909 of the 32
58	58		general statutes. 33
59	59		(b) No policy described in subsection (a) of this section shall impose 34
60	60		a coinsurance, copayment, deductible or other out-of-pocket expense for 35
61	61		the epinephrine cartridge injector that such policy is required to cover 36
62	62		pursuant to said subsection (a) in an amount that is greater than twenty-37
63	63		five dollars. The provisions of this subsection shall apply to a high 38
64	64		deductible health plan, as that term is used in subsection (f) of section 39
65	65		38a-520 of the general statutes, to the maximum extent permitted by 40
66	66		federal law, except if such plan is used to establish a medical savings 41
67	67		account or an Archer MSA pursuant to Section 220 of the Internal 42
68	68		Revenue Code of 1986, or any subsequent corresponding internal 43
69	69		revenue code of the United States, as amended from time to time, or a 44
70	70		health savings account pursuant to Section 223 of said Internal Revenue 45
71	71		Code, as amended from time to time. The provisions of this subsection 46
72	72		shall apply to such high deductible health plans to the maximum extent 47
73	73		that (1) is permitted by federal law, and (2) does not disqualify such 48
74	74		account for the deduction allowed under Section 220 or 223, of said the 49
75	75		Internal Revenue Code of 1986, as applicable. 50 Substitute Bill No. 5386
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82	82		Sec. 3. Section 38a-479ooo of the general statutes is repealed and the 51
83	83		following is substituted in lieu thereof (Effective January 1, 2023): 52
84	84		For the purposes of this part and section 4 of this act: 53
85	85		(1) "Commissioner" means the Insurance Commissioner. 54
86	86		(2) "Department" means the Insurance Department. 55
87	87		(3) "Drug" has the same meaning as provided in section 21a-92. 56
88	88		(4) "Health care plan" means an individual or a group health 57
89	89		insurance policy that provides coverage of the types specified in 58
90	90		subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and includes 59
91	91		coverage for outpatient prescription drugs. 60
92	92		(5) "Health carrier" means an insurance company, health care center, 61
93	93		hospital service corporation, medical service corporation, fraternal 62
94	94		benefit society or other entity that delivers, issues for delivery, renews, 63
95	95		amends or continues a health care plan in this state. 64
96	96		(6) "Person" has the same meaning as provided in section 38a-1. 65
97	97		(7) "Pharmacist" has the same meaning as provided in section 38a-66
98	98		479aaa. 67
99	99		(8) "Pharmacist services" has the same meaning as provided in section 68
100	100		38a-479aaa. 69
101	101		(9) "Pharmacy" has the same meaning as provided in section 38a-70
102	102		479aaa. 71
103	103		(10) "Pharmacy benefits manager" or "manager" means any person 72
104	104		that administers the prescription drug, prescription device, pharmacist 73
105	105		services or prescription drug and device and pharmacist services 74
106	106		portion of a health care plan on behalf of a health carrier. 75
107	107		(11) (A) "Rebate" means a discount or concession, which affects the 76 Substitute Bill No. 5386
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114	114		price of an outpatient prescription drug, that a pharmaceutical 77
115	115		manufacturer directly provides to a (i) health carrier for an outpatient 78
116	116		prescription drug manufactured by the pharmaceutical manufacturer, 79
117	117		or (ii) pharmacy benefits manager after the manager processes a claim 80
118	118		from a pharmacy or a pharmacist for an outpatient prescription drug 81
119	119		manufactured by the pharmaceutical manufacturer. 82
120	120		(B) "Rebate" does not mean a bona fide service fee, as such term is 83
121	121		defined in Section 447.502 of Title 42 of the Code of Federal Regulations, 84
122	122		as amended from time to time. 85
123	123		(12) "Specialty drug" means a prescription outpatient specialty drug 86
124	124		covered under the Medicare Part D program established pursuant to 87
125	125		Public Law 108-173, the Medicare Prescription Drug, Improvement, and 88
126	126		Modernization Act of 2003, as amended from time to time, that exceeds 89
127	127		the specialty tier cost threshold established by the Centers for Medicare 90
128	128		and Medicaid Services. 91
129	129		Sec. 4. (NEW) (Effective January 1, 2023) On or after January 1, 2023, 92
130	130		each contract entered into between a health carrier and a pharmacy 93
131	131		benefits manager that requires the pharmacy benefits manager to 94
132	132		administer the prescription drug, prescription device, pharmacist 95
133	133		services or prescription drug and device and pharmacist services 96
134	134		portion of a health care plan on behalf of the health carrier shall, if the 97
135	135		pharmacy benefits manager utilizes a tiered prescription drug 98
136	136		formulary, require the pharmacy benefits manager to include at least 99
137	137		one covered epinephrine cartridge injector, as defined in section 19a-909 100
138	138		of the general statutes, in the cost-sharing tier that imposes the lowest 101
139	139		coinsurance, copayment, deductible or other out-of-pocket expense for 102
140	140		covered prescription drugs. 103
141	141		This act shall take effect as follows and shall amend the following
142	142		sections:
143	143
144	144		Section 1 January 1, 2023 New section
145	145		Sec. 2 January 1, 2023 New section
146	146		Sec. 3 January 1, 2023 38a-479ooo Substitute Bill No. 5386
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153	153		Sec. 4 January 1, 2023 New section
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	155	+	Statement of Legislative Commissioners:
	156	+	The title of the bill was changed for accuracy.
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156	158		INS Joint Favorable Subst.
157		-	APP Joint Favorable
158	159