An Act Concerning Copay Accumulator Programs And High Deductible Health Plans.
Impact
If enacted, SB00357 will significantly alter the procedures related to high deductible health plans and pharmacy benefits in Connecticut. Specifically, the bill mandates that health insurers and managed care organizations account for external financial assistance when determining out-of-pocket expenses owed by patients. This means that individuals enrolled in high deductible health plans will experience a decrease in the financial burden associated with their healthcare, as previous limitations on recognizing discount contributions for deductibles will be removed. The legal adjustments will apply to contracts issued or renewed beginning January 1, 2022.
Summary
SB00357, titled 'An Act Concerning Copay Accumulator Programs and High Deductible Health Plans', aims to modify insurance policies concerning how deductibles and copayments are calculated by requiring insurance providers to give credit for discounts and payments made by third parties. This legislation targets the issues faced by insured individuals under high deductible health plans, especially those relying on pharmacy benefit managers. The intent is to reduce the out-of-pocket expenses that accrue for insured individuals by ensuring that external discounts are acknowledged during the cost calculations of their prescribed medicines, ultimately promoting accessibility and affordability in healthcare.
Sentiment
The sentiment surrounding SB00357 appears to be largely favorable among healthcare advocates and lawmakers, as the measure addresses significant concerns related to affordability in healthcare. Supporters argue that the bill would enhance transparency in billing practices and contribute to alleviating the financial strain endured by many patients, particularly those with chronic conditions that necessitate ongoing medication. However, there may be concerns related to how stringent enforcement will be among insurers, and whether the financial incentives for managed care organizations will align with the intent of the legislation.
Contention
Though generally seen as a positive legislative move, some points of contention arise regarding the implementation of these provisions. Questions remain as to how insurers and pharmacy benefit managers will adapt their practices to remain compliant with the new calculation requirements. Additionally, any potential pushback from insurance companies regarding profitability and operational changes posed by this bill could generate debate in legislative discussions, as insurers may fear rising operational costs or adjustments in their pricing structures in response to the mandate.
An Act Concerning Insurance Market Conduct And Insurance Licensing, The Insurance Department's Technical Corrections And Other Revisions To The Insurance Statutes And Captive Insurance.