Connecticut 2025 Regular Session

Connecticut House Bill HB06436 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	LCO 1 of 5
	3	+	LCO No. 2303 1 of 5
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5		-	General Assembly ~~Substitute~~ Bill No. 6436
	5	+	General Assembly Raised Bill No. 6436
6	6		January Session, 2025
	7	+	LCO No. 2303
	8	+
	9	+
	10	+	Referred to Committee on INSURANCE AND REAL ESTATE
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	13	+	Introduced by:
	14	+	(INS)
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10	19		AN ACT CONCERNING REVISIONS TO THE HEALTH INSURANCE
11	20		STATUTES.
12	21		Be it enacted by the Senate and House of Representatives in General
13	22		Assembly convened:
14	23
15	24		Section 1. Subsection (b) of section 38a-21 of the general statutes is 1
16	25		repealed and the following is substituted in lieu thereof (Effective October 2
17	26		1, 2025): 3
18	27		(b) (1) There is established within the Insurance Department a health 4
19	28		benefit review program for the review and evaluation of any mandated 5
20	29		health benefit that is requested by the joint standing committee of the 6
21	30		General Assembly having cognizance of matters relating to insurance. 7
22	31		Such program shall be funded by the Insurance Fund established under 8
23	32		section 38a-52a. The commissioner shall be authorized to make 9
24	33		assessments in a manner consistent with the provisions of chapter 698 10
25	34		for the costs of carrying out the requirements of this section. Such 11
26	35		assessments shall be in addition to any other taxes, fees and moneys 12
27	36		otherwise payable to the state. The commissioner shall deposit all 13
28	37		payments made under this section with the State Treasurer. The moneys 14
29	38		deposited shall be credited to the Insurance Fund and shall be accounted 15
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	43	+	LCO No. 2303 2 of 5
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30	45		for as expenses recovered from insurance companies. Such moneys shall 16
31	46		be expended by the commissioner to carry out the provisions of this 17
32	47		section and section 2 of public act 09-179. 18
33		-	(2) The commissioner [shall contract with The University of 19 Substitute Bill No. 6436
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36		-	LCO 2 of 5
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	48	+	(2) The commissioner [shall contract with The University of 19
38	49		Connecticut Center for Public Health and Health Policy to conduct] may 20
39	50		engage the services of any actuary, actuarial firm, quality improvement 21
40	51		clearinghouse, health policy research organization or any other 22
41		-	independent expert as the commissioner deems necessary to assist ~~the~~ 23
	52	+	independent expert as the commissioner deems necessary to assist said 23
42	53		commissioner in the review and evaluation of any mandated health 24
43	54		benefit review requested pursuant to subsection (c) of this section. [The 25
44	55		director of said center may engage the services of an actuary, quality 26
45	56		improvement clearinghouse, health policy research organization or any 27
46	57		other independent expert, and may engage or consult with any dean, 28
47	58		faculty or other personnel said director deems appropriate within The 29
48	59		University of Connecticut schools and colleges, including, but not 30
49	60		limited to, The University of Connecticut (A) School of Business, (B) 31
50	61		School of Dental Medicine, (C) School of Law, (D) School of Medicine, 32
51	62		and (E) School of Pharmacy.] 33
52	63		Sec. 2. Section 38a-479ppp of the general statutes is repealed and the 34
53	64		following is substituted in lieu thereof (Effective from passage): 35
54	65		(a) Not later than [February 1, 2025] March 1, 2026, and annually 36
55	66		thereafter, each pharmacy benefits manager shall file a report with the 37
56	67		commissioner for the immediately preceding calendar year. The report 38
57	68		shall contain the following information for health carriers that 39
58	69		delivered, issued for delivery, renewed, amended or continued health 40
59	70		care plans that included a pharmacy benefit managed by the pharmacy 41
60	71		benefits manager during such calendar year: 42
61	72		(1) The aggregate dollar amount of all rebates concerning drug 43
62	73		formularies used by such health carriers that such manager collected 44
63	74		from pharmaceutical manufacturers that manufactured outpatient 45
64	75		prescription drugs that (A) were covered by such health carriers during 46
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65	82		such calendar year, and (B) are attributable to patient utilization of such 47
66	83		drugs during such calendar year; and 48
67	84		(2) The aggregate dollar amount of all rebates, excluding any portion 49
68	85		of the rebates received by such health carriers, concerning drug 50
69		-	formularies that such manager collected from pharmaceutical 51 Substitute Bill No. 6436
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72		-	LCO 3 of 5
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	86	+	formularies that such manager collected from pharmaceutical 51
74	87		manufacturers that manufactured outpatient prescription drugs that (A) 52
75	88		were covered by such health carriers during such calendar year, and (B) 53
76	89		are attributable to patient utilization of such drugs by covered persons 54
77	90		under such health care plans during such calendar year. 55
78	91		(b) The commissioner shall establish a standardized form for 56
79	92		reporting information pursuant to subsection (a) of this section after 57
80	93		consultation with pharmacy benefits managers. The form shall be 58
81	94		designed to minimize the administrative burden and cost of reporting 59
82	95		on the department and pharmacy benefits managers. 60
83	96		(c) All information submitted to the commissioner pursuant to 61
84	97		subsection (a) of this section shall be exempt from disclosure under the 62
85	98		Freedom of Information Act, as defined in section 1-200, except to the 63
86	99		extent such information is included on an aggregated basis in the report 64
87	100		required by subsection (d) of this section. The commissioner shall not 65
88	101		disclose information submitted pursuant to subdivision (1) of 66
89	102		subsection (a) of this section, or information submitted pursuant to 67
90	103		subdivision (2) of said subsection in a manner that (1) is likely to 68
91	104		compromise the financial, competitive or proprietary nature of such 69
92	105		information, or (2) would enable a third party to identify a health care 70
93	106		plan, health carrier, pharmacy benefits manager, pharmaceutical 71
94	107		manufacturer, or the value of a rebate provided for a particular 72
95	108		outpatient prescription drug or therapeutic class of outpatient 73
96	109		prescription drugs. 74
97	110		(d) Not later than [March 1, 2025] April 1, 2026, and annually 75
98	111		thereafter, the commissioner shall submit a report, in accordance with 76
99	112		section 11-4a, to the joint standing committee of the General Assembly 77
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100	119		having cognizance of matters relating to insurance. The report shall 78
101	120		contain (1) an aggregation of the information submitted to the 79
102	121		commissioner pursuant to subsection (a) of this section for the 80
103	122		immediately preceding calendar year, and (2) such other information as 81
104	123		the commissioner, in the commissioner's discretion, deems relevant for 82
105	124		the purposes of this section. Not later than ten days prior to the 83
106		-	submission of the annual report pursuant to the provisions of this 84 Substitute Bill No. 6436
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109		-	LCO 4 of 5
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	125	+	submission of the annual report pursuant to the provisions of this 84
111	126		subsection, the commissioner shall provide each pharmacy benefits 85
112	127		manager and any third party affected by submission of such report 86
113	128		required by this subsection with a written notice describing the content 87
114	129		of the report. 88
115	130		(e) The commissioner may impose a penalty of not more than seven 89
116	131		thousand five hundred dollars on a pharmacy benefits manager for each 90
117	132		violation of this section. 91
118	133		(f) The commissioner may adopt regulations, in accordance with the 92
119	134		provisions of chapter 54, to implement the provisions of this section. 93
120	135		Sec. 3. Subsection (c) of section 38a-492w of the general statutes is 94
121	136		repealed and the following is substituted in lieu thereof (Effective from 95
122	137		passage): 96
123	138		(c) The Insurance Commissioner [shall] may adopt regulations, in 97
124	139		accordance with chapter 54, to implement the provisions of this section. 98
125	140		Sec. 4. Subsection (c) of section 38a-518w of the general statutes is 99
126	141		repealed and the following is substituted in lieu thereof (Effective from 100
127	142		passage): 101
128	143		(c) The Insurance Commissioner [shall] may adopt regulations, in 102
129	144		accordance with chapter 54, to implement the provisions of this section.103
130	145		This act shall take effect as follows and shall amend the following
131	146		sections:
132	147
133	148		Section 1 October 1, 2025 38a-21(b)
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134	155		Sec. 2 from passage 38a-479ppp
135	156		Sec. 3 from passage 38a-492w(c)
136	157		Sec. 4 from passage 38a-518w(c)
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138		-	Statement of Legislative Commissioners:
139		-	In Section 1(b)(2), "said commissioner" was changed to "the
140		-	commissioner", for accuracy.
141		-
142		-	INS Joint Favorable Subst. -LCO Substitute Bill No. 6436
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145		-	LCO 5 of 5
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	159	+	Statement of Purpose:
	160	+	To: (1) Eliminate the requirement that the Insurance Commissioner
	161	+	contract with certain entities that no longer exist to conduct reviews of
	162	+	mandated health benefits, and allow said commissioner to engage the
	163	+	services of organizations that may assist in the review of mandated
	164	+	health benefits; (2) revise annual reporting dates concerning pharmacy
	165	+	benefits manager rebate information; and (3) eliminate the requirement
	166	+	that the Insurance Commissioner adopt regulations to implement health
	167	+	insurance coverage requirements concerning medically necessary
	168	+	wheelchair repairs and replacements.
	169	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	170	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	171	+	underlined.]
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