LCO \\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202-R01- SB.docx 1 of 10 General Assembly Substitute Bill No. 202 February Session, 2024 AN ACT CONCERNING THE DEPARTMENT OF CONSUMER PROTECTION'S RECOMMENDATIONS REGARDING PRESCRIPTION DRUG CONTROL. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Subsection (a) of section 21a-65 of the 2024 supplement to 1 the general statutes is repealed and the following is substituted in lieu 2 thereof (Effective from passage): 3 (a) A licensed manufacturer or licensed wholesaler may sell 4 hypodermic needles and syringes only to the following: (1) To a licensed 5 manufacturer, licensed wholesaler or licensed pharmacy; (2) to [a] an 6 advanced practice registered nurse, dentist, embalmer, optometrist, 7 physician, [dentist,] physician assistant, podiatrist, scientific 8 investigator or veterinarian [, embalmer, podiatrist or scientific 9 investigator] licensed to practice in this state; (3) to a person in charge of 10 a care-giving institution, as defined in section 20-571, incorporated 11 college or scientific institution, but only for use by or in such care-giving 12 institution, college or institution for medical or scientific purposes; (4) 13 to a person in charge of a licensed or registered laboratory, but only for 14 use in that laboratory for scientific and medical purposes; (5) to a farmer 15 but only for use on the farmer's own animals or poultry; (6) to a business 16 authorized in accordance with the regulations adopted under section 17 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 2 of 10 21a-66 to purchase hypodermic needles and syringes but only for 18 legitimate industrial or medical use within that business; and (7) to a 19 syringe services program established pursuant to section 19a-124. 20 Sec. 2. Section 21a-70h of the 2024 supplement to the general statutes 21 is repealed and the following is substituted in lieu thereof (Effective from 22 passage): 23 For the purposes of this section and sections 21a-70i to 21a-70k, as 24 amended by this act: 25 (1) "Commissioner" means the Commissioner of Consumer 26 Protection or the commissioner's authorized representative; 27 (2) "Contact" means any communication transmitted in person or by 28 telephone, electronic mail, text message or other electronic means 29 between a pharmaceutical representative and a prescribing practitioner 30 or pharmacist, to promote or provide information relating to a legend 31 drug; 32 (3) "Department" means the Department of Consumer Protection; 33 (4) "Legend drug" has the same meaning as provided in section 20-34 571; 35 (5) "Pharmaceutical manufacturer" (A) means a [(A)] (i) person, 36 whether within or without the boundaries of the state of Connecticut, 37 that (I) produces, prepares, cultivates, grows, propagates, compounds, 38 converts or processes a drug, [device or cosmetic,] directly or indirectly, 39 by extraction from substances of natural origin, by means of chemical 40 synthesis or by a combination of extraction and chemical synthesis, or 41 [that] (II) packages, repackages, labels or relabels a drug container under 42 such manufacturer's own trademark or label, or any other trademark or 43 label, [or a drug, device or cosmetic] for the purpose of selling the drug, 44 [device or cosmetic,] or [(B)] (ii) sterile compounding pharmacy, as 45 defined in section 20-633b that dispenses sterile pharmaceuticals 46 without a prescription or a patient-specific medical order intended for 47 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 3 of 10 use in humans, and (B) includes, but is not limited to, a virtual 48 manufacturer, as defined in section 20-571; 49 [(6) "Pharmaceutical manufacturer" includes a virtual manufacturer, 50 as defined in section 20-571;] 51 [(7)] (6) "Pharmaceutical marketing firm" means a pharmaceutical 52 manufacturer that employs or compensates pharmaceutical 53 representatives; 54 [(8)] (7) "Pharmaceutical representative" means any person, 55 including, but not limited to, a sales representative, who markets, 56 promotes or provides information regarding a legend drug for human 57 use to a prescribing practitioner and is employed or compensated by a 58 pharmaceutical manufacturer; 59 [(9)] (8) "Pharmacist" has the same meaning as provided in section 20-60 571; and 61 [(10)] (9) "Prescribing practitioner" has the same meaning as provided 62 in section 20-571. 63 Sec. 3. Section 21a-70i of the 2024 supplement to the general statutes 64 is repealed and the following is substituted in lieu thereof (Effective from 65 passage): 66 (a) On and after October 1, 2023, a pharmaceutical manufacturer that 67 employs [an individual to perform the duties of] a pharmaceutical 68 [sales] representative shall register annually with the department as a 69 pharmaceutical marketing firm, in a form and manner prescribed by the 70 commissioner. No pharmaceutical manufacturer shall authorize an 71 individual to perform [such] the duties of a pharmaceutical 72 representative on such manufacturer's behalf unless such manufacturer 73 has obtained a pharmaceutical marketing firm registration from the 74 department pursuant to this section. Registrations issued pursuant to 75 this section shall expire annually on June thirtieth. 76 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 4 of 10 (b) The nonrefundable fee for registration as a pharmaceutical 77 marketing firm and for annual renewal of such registration shall be one 78 hundred fifty dollars. Any pharmaceutical marketing firm that fails to 79 renew its registration on or before June thirtieth shall pay a late fee of 80 one hundred dollars for each year that such firm did not renew, in 81 addition to the annual renewal fee required under this section. 82 (c) On the date of its initial registration, and annually thereafter, each 83 pharmaceutical marketing firm shall provide to the department a list of 84 all [individuals] pharmaceutical representatives employed or 85 compensated by such firm. [as a pharmaceutical sales representative.] 86 Each pharmaceutical marketing firm shall notify the department, in a 87 form and manner prescribed by the commissioner, of each individual 88 who is no longer employed or compensated as a pharmaceutical [sales] 89 representative or who was hired or compensated as a pharmaceutical 90 representative after the date on which such firm provided such annual 91 list, not later than two weeks after such individual leaves employment 92 or was hired or otherwise compensated. 93 (d) The department shall prominently post on its Internet web site the 94 most recent list provided by each pharmaceutical marketing firm 95 pursuant to subsection (c) of this section. 96 (e) Any person who is not identified to the department pursuant to 97 subsection (c) of this section shall not perform the duties of a 98 pharmaceutical [sales] representative on behalf of the pharmaceutical 99 marketing firm. [for any prescribing practitioner in this state.] 100 (f) Not later than July 1, 2024, and annually thereafter, each 101 pharmaceutical marketing firm shall provide the commissioner with the 102 following information regarding the performance for the previous 103 calendar year of each of its pharmaceutical [sales] representatives 104 identified to the department pursuant to subsection (c) of this section at 105 any time during the previous calendar year, in a form and manner 106 prescribed by the commissioner: 107 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 5 of 10 (1) The aggregate number of contacts such pharmaceutical [sales] 108 representative had with prescribing practitioners and pharmacists; 109 (2) The specialty of [each] such prescribing practitioner and each 110 pharmacist with whom such pharmaceutical [sales] representative 111 made contact; 112 (3) Whether product samples, materials or gifts of any value were 113 provided to a prescribing practitioner or such practitioner's staff in a 114 prescribing practitioner's office or to a pharmacist; and 115 (4) An aggregate report of all free samples, by drug name and 116 strength, in a form and manner prescribed by the commissioner. 117 (g) The department shall annually [analyze the information 118 submitted pursuant to this section and] compile a report on the activities 119 of pharmaceutical [sales representatives] marketing firms in the state. 120 Not later than December [1] 31, 2024, and annually thereafter, the 121 department shall post such report on its Internet web site and submit 122 such report to the Secretary of the Office of Policy and Management. 123 Sec. 4. Section 21a-70j of the 2024 supplement to the general statutes 124 is repealed and the following is substituted in lieu thereof (Effective from 125 passage): 126 Each pharmaceutical marketing firm that employs or compensates a 127 pharmaceutical representative who is engaged in marketing, promoting 128 or providing information regarding a legend drug [marketing] for 129 human use in this state shall [disclose] ensure that such pharmaceutical 130 representative discloses, in writing, to a prescribing practitioner or 131 pharmacist, [at the] each time [of each] such pharmaceutical 132 representative makes contact with [such] the prescribing practitioner or 133 pharmacist: [, the following information:] 134 (1) The list price of a legend drug when such pharmaceutical 135 representative provides information concerning [such] the legend drug 136 to [the] such prescribing practitioner or pharmacist based on the dose 137 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 6 of 10 and quantity of such legend drug as described in the medication 138 package insert; and 139 (2) Information on the variation efficacy of the legend drug marketed 140 to different racial and ethnic groups, if such information is available. 141 Sec. 5. Section 19a-17d of the 2024 supplement to the general statutes 142 is repealed and the following is substituted in lieu thereof (Effective from 143 passage): 144 If a [pharmacist or] health care professional who is currently licensed 145 or was previously licensed in another state or jurisdiction is subject to 146 automatic reciprocal discipline for a disciplinary action in such state or 147 jurisdiction, such automatic reciprocal discipline shall be automatically 148 rescinded and shall not be entered into the licensing record of the 149 [pharmacist or] health care professional if the discipline was based 150 solely on the termination of pregnancy under conditions that would not 151 violate the general statutes or the regulations of Connecticut state 152 agencies. The provisions of this section shall not preclude or affect the 153 ability of an agency or board of the state to seek or impose any discipline 154 pursuant to the general statutes against a [pharmacist or other] health 155 care professional licensed by the state. 156 Sec. 6. Subsection (a) of section 21a-70k of the 2024 supplement to the 157 general statutes is repealed and the following is substituted in lieu 158 thereof (Effective from passage): 159 (a) The commissioner may (1) refuse to authorize the issuance or 160 renewal of a registration to operate as a pharmaceutical marketing firm, 161 (2) revoke, suspend or place conditions on a registration to operate as a 162 pharmaceutical marketing firm, and (3) assess a penalty of up to one 163 thousand dollars for each violation of any provision of section 21a-70i, 164 as amended by this act, or 21a-70j, as amended by this act, or take other 165 action permitted by [subdivision (7) of subsection (a) of section 21a-7] 166 section 21a-11, if the applicant or holder of the registration fails to 167 comply with the requirements set forth in section 21a-70i, as amended 168 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 7 of 10 by this act, or 21a-70j, as amended by this act. 169 Sec. 7. Section 21a-322 of the general statutes is repealed and the 170 following is substituted in lieu thereof (Effective from passage): 171 (a) The [commissioner] Commissioner of Consumer Protection may 172 suspend, revoke or refuse to renew a registration, place a registration on 173 probation, place conditions on a registration and assess a civil penalty 174 of not more than one thousand dollars per violation of this chapter, for 175 sufficient cause. Any of the following shall be sufficient cause for such 176 action by the commissioner: (1) The furnishing of false or fraudulent 177 information in any application filed under this chapter; (2) conviction of 178 a crime under any state or federal law relating to the registrant's 179 profession, controlled substances or drugs or fraudulent practices, 180 including, but not limited to, fraudulent billing practices; (3) failure to 181 maintain effective controls against diversion of controlled substances 182 into other than duly authorized legitimate medical, scientific, or 183 commercial channels; (4) the suspension, revocation, expiration or 184 surrender of the practitioner's federal controlled substance registration; 185 (5) prescribing, distributing, administering or dispensing a controlled 186 substance in schedules other than those specified in the practitioner's 187 state or federal registration or in violation of any condition placed on 188 the practitioner's registration; (6) suspension, revocation, expiration, 189 surrender or other disciplinary action taken against any professional 190 license or registration held by the practitioner; (7) abuse or excessive use 191 of drugs; (8) possession, use, prescription for use or distribution of 192 controlled substances or legend drugs, except for therapeutic or other 193 proper medical or scientific purpose; (9) a practitioner's failure to 194 account for disposition of controlled substances as determined by an 195 audit of the receipt and disposition records of said practitioner; (10) 196 failure to keep records of medical evaluations of patients and all 197 controlled substances dispensed, administered or prescribed to patients 198 by a practitioner; (11) failure to establish and implement administrative 199 safeguards for the protection of electronic protected health information 200 pursuant to 45 CFR 164.308, as amended from time to time; and (12) 201 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 8 of 10 breach of any such safeguards by a prescribing practitioner's authorized 202 agent. 203 (b) If a practitioner dispenses, administers or prescribes any 204 controlled substance to a patient, the practitioner shall make available 205 to the Department of Consumer Protection, for inspection by the 206 department, records of medical evaluations associated with dispensing, 207 administering or prescribing such controlled substance. Such records 208 shall be confidential and not be subject to disclosure under the Freedom 209 of Information Act, as defined in section 1-200. The department may 210 inspect such records solely for the purpose of investigating any violation 211 or suspected violation, or enforcing any provision, of this chapter or any 212 regulation promulgated under this chapter. Nothing in this subsection 213 shall be construed to require disclosure of any substance abuse 214 treatment record that is protected from disclosure under 42 USC 290dd-215 2, as amended from time to time, or other applicable federal law. 216 Sec. 8. Subparagraphs (A) and (B) of subdivision (10) of subsection (j) 217 of section 21a-254 of the general statutes are repealed and the following 218 is substituted in lieu thereof (Effective from passage): 219 (10) (A) A prescribing practitioner may designate an authorized 220 agent to review the electronic prescription drug monitoring program 221 and patient controlled substance prescription information on behalf of 222 the prescribing practitioner. The prescribing practitioner shall ensure 223 that any authorized agent's access to such program and patient 224 controlled substance prescription information is limited to the purposes 225 described in this section and occurs in a manner that protects the 226 confidentiality of information that is accessed through such program. 227 The prescribing practitioner and any authorized agent shall be subject 228 to the provisions of 45 CFR 164.308, as amended from time to time, 229 concerning administrative safeguards for the protection of electronic 230 protected health information. A prescribing practitioner may be subject 231 to disciplinary action for acts of the authorized agent as provided in 232 subsection (a) of section 21a-322, as amended by this act. 233 Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 9 of 10 (B) Notwithstanding the provisions of subparagraph (A) of this 234 subdivision, a prescribing practitioner who is employed by or provides 235 professional services to a hospital shall, prior to designating an 236 authorized agent to review the electronic prescription drug monitoring 237 program and patient controlled substance prescription information on 238 behalf of the prescribing practitioner, (i) submit a request to designate 239 one or more authorized agents for such purposes and a written protocol 240 for oversight of the authorized agent or agents to the commissioner, in 241 the form and manner prescribed by the commissioner, and (ii) receive 242 the commissioner's approval to designate such authorized agent or 243 agents and of such written protocol. Such written protocol shall 244 designate either the hospital's medical director, a hospital department 245 head, who is a prescribing practitioner, or another prescribing 246 practitioner as the person responsible for ensuring that the authorized 247 agent's or agents' access to such program and patient controlled 248 substance prescription information is limited to the purposes described 249 in this section and occurs in a manner that protects the confidentiality 250 of information that is accessed through such program. A hospital 251 medical director, a hospital department head, who is a prescribing 252 practitioner, or another prescribing practitioner designated as the 253 person responsible for overseeing an authorized agent's or agents' 254 access to such program and information in the written protocol 255 approved by the commissioner may be subject to disciplinary action for 256 acts of the authorized agent or agents as provided in subsection (a) of 257 section 21a-322, as amended by this act. The commissioner may inspect 258 hospital records to determine compliance with written protocols 259 approved in accordance with this section. 260 This act shall take effect as follows and shall amend the following sections: Section 1 from passage 21a-65(a) Sec. 2 from passage 21a-70h Sec. 3 from passage 21a-70i Sec. 4 from passage 21a-70j Sec. 5 from passage 19a-17d Substitute Bill No. 202 LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2024SB-00202- R01-SB.docx } 10 of 10 Sec. 6 from passage 21a-70k(a) Sec. 7 from passage 21a-322 Sec. 8 from passage 21a-254(j)(10)(A) and (B) Statement of Legislative Commissioners: In Section 7(b), ", as amended from time to time," was added for consistency with standard drafting conventions. GL Joint Favorable Subst.