OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
SB-6
AN ACT CONCERNING UTILIZATION REVIEW AND HEALTH
CARE CONTRACTS, HEALTH INSURANCE COVERAGE FOR
NEWBORNS AND STEP THERAPY.
As Amended by Senate "A" (LCO 8168), Senate "B" (LCO 8181)
Senate Calendar No.: 197
Primary Analyst: NN 5/18/23
Contributing Analyst(s): SB, MP
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 24 $ FY 25 $
State Comptroller - Fringe
Benefits
GF - Potential
Cost
See Below See Below
Note: GF=General Fund
Municipal Impact:
Municipalities Effect FY 24 $ FY 25 $
Various Municipalities Potential
Cost
See Below See Below
Explanation
The bill makes various changes related to health insurance and
utilization review, resulting in the fiscal impacts described by section
below.
Sections 1 – 2 prohibit the requirement of utilization review for
already approved prescription drugs used to treat an autoimmune
disorder, multiple sclerosis, or cancer after January 1, 2025. This
decreases the health carriers' ability to lower costs, and in turn may
impact state and municipal health plans through increased premiums
in FY 25.
Section 3 shortens several of the maximum timeframes for insurers 2023SB-00006-R01-FN.DOCX Page 2 of 3
to notify insureds of their utilization review decisions. As these
provisions impact private entities, there is no anticipated fiscal impact
to the state or municipalities.
Sections 4 - 5 extend the time frame insurers must provide for notice
of birth of a newborn from sixty-one days to ninety-one days, which
may result in a fiscal impact to the state and municipal plans to the
extent that the number of claims increases.
Sections 6 – 7 reduce the time period from sixty to thirty days for the
use of step therapy, which results in a potential cost to the state and
municipal plans through increases in drug usage within a shortened
time frame and administrative costs. The amendment also eliminates
step therapy for certain behavioral health conditions for three years.
This has no fiscal impact on the state, however, may impact certain
municipal plans that require step therapy.
Section 8 establishes a task force to study data collection efforts
regarding step therapy, which has no fiscal impact because the task
force is anticipated to have the expertise to meet the requirements of the
bill.
Sections 9 – 10 require health carriers to submit additional
information annually to the Insurance Department (DOI) related to
prior authorization, which DOI must incorporate into an existing
agency report. This has no anticipated fiscal impact to the state as DOI
has the expertise to meet the requirements of the bill.
Section 11, which requires providers to use a health carrier’s
electronic program for prior authorization, does not result in a fiscal
impact to UConn Health Center.
House "A" strikes the underlying bill and its associated fiscal impact,
resulting in the fiscal impact described above (except for the impact of
House "B", described below).
House "B" changes the effective date of Section 2 (in the bill as
amended by House "A") from January 1, 2024, to January 1, 2025, 2023SB-00006-R01-FN.DOCX Page 3 of 3
delaying by one year the potential costs associated with that section.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to the number of claims filed and usage
reflected in higher premiums.
The preceding Fiscal Impact statement is prepared for the benefit of the members of the General Assembly, solely
for the purposes of information, summarization and explanation and does not represent the intent of the General
Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of
informational sources, including the analyst’s professional knowledge. Whenever applicable, agency data is
consulted as part of the analysis, however final products do not necessarily reflect an assessment from any
specific department.