OFFICE OF FISCAL ANALYSIS
Legislative Office Building, Room 5200
Hartford, CT 06106 (860) 240-0200
http://www.cga.ct.gov/ofa
sSB-182
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM
REQUIRING STEP THERAPY FOR PRESCRIPTION DRUGS USED
TO TREAT A MENTAL OR BEHAVIORAL HEALTH CONDITION
OR A CHRONIC, DISABLING OR LIFE -THREATENING
CONDITION.
Primary Analyst: NN 3/12/24
Contributing Analyst(s):
OFA Fiscal Note
State Impact:
Agency Affected Fund-Effect FY 25 $ FY 26 $
State Comptroller - Fringe
Benefits
GF - Cost See Below See Below
Note: GF=General Fund
Municipal Impact:
Municipalities Effect FY 25 $ FY 26 $
Various Municipalities STATE
MANDATE
1
- Cost
See Below See Below
Explanation
The bill, which eliminates a health carrier's use of step therapy,
results in a cost to the State Comptroller - Fringe Benefits account
annually dependent on claims data for the state employee health plan.
Step therapy is used as a cost management tool, and its prohibition for
prescription drugs to treat a mental or behavioral health, chronic,
disabling, or life-threatening condition or disease is likely to be reflected
in higher premiums for the state employee health plan through an
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. 2024SB-00182-R000020-FN.DOCX Page 2 of 2
increased per member per month cost. The conditions listed in the bill
are associated with the highest claimants on the plans, whose claims are
largely driven by prescription drug costs. The elimination of step
therapy for these conditions, as well as the lower step therapy maximum
time frame for all other conditions will result in a fiscal impact to the
state, assuming an increase in claim costs.
The bill also results in potential costs to various municipalities
that have either self or fully insured health plans or participate in the
Partnership plan to the extent higher claim costs increase plan
premiums. Fully insured municipalities will face costs up to $3.72 per
member per month (pmpm) as an estimate based on carrier data
2
. This
rate is subject to change. Due to federal law, self-insured health plans
are exempt from state health insurance benefit mandates, so potential
costs are contingent on the plan electing to adopt the mandate.
The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject to inflation.
Sources: State Employee Health Plan Provider
2
The pmpm estimate compares national step therapy data with state level
prescriptions costs to determine an attributable state cost.