SB 331 — AN ACT CONCERNING STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR IMPOSITION OF NEW REQUIREMENTS.

Senate General Assembly FileSubstitute Bill No.

462331 February Session, 2026 SubstituteAN SenateACT BillCONCERNING No.STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR IMPOSITION OF NEW REQUIREMENTS.

331 Senate, April 7, 2026 The Committee on Human Services reported through SEN.

LESSER of the 9th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR IMPOSITION OF NEW REQUIREMENTS.

When the prescribing practitioner deems the treatment to be clinically ineffective, the drug prescribed and recommended by the practitioner shall be dispensed and covered under sSB331the /Medicaid Fileprogram. No.

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462 the Medicaid program.

(NEW) (Effective from passage) (a) The Department of Social Services, or any entityunder contract withthedepartment to administer pharmacy benefits, shall provide the following notice to a HUSKY HealthLCO plan1 enrolleeof affected3 bySubstitute aBill decisionNo. by the department to deny or suspend payment for a prescription drug or institute new step therapy or prior authorization requirements:

331 Health plan enrollee affected by a decision by the department to deny or suspend payment for a prescription drug or institute new step therapy or prior authorization requirements:

(2)For a plannedelectronicsuspension or terminationofpaymenttermination ofpayment for a prescribed prescription drug, written notice by United States mail not later than ten days before such suspension or termination;

sSB331This /act Fileshall No.take effect as follows and shall amend the following sections:

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462 This act shall take effect as follows and shall amend the following sections:

2 from passage New section StatementLCO 2 of Legislative3 Commissioners:Substitute Bill No.

Sections331 2HS toJoint 4,Favorable inclusive,Subst. were consolidated into Section 2 and redrafted for clarity.

HSAPP Joint Favorable Subst.LCO 3 of 3

sSB331 / File No.

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462 The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do 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.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 27 $ FY 28 $ Social Services, Dept.

GF - Cost/ See Below See Below Savings Note:

GF=General Fund Municipal Impact:

None Explanation Section1resultsinsavingstotheDepartmentofSocialServices(DSS) to the extent step therapy is utilized beyond the current 30-day limit.

The scope of savings is dependent on the cost and number of days the preferreddrugiscontinuedcomparedtothecostof thesubsequentdrug prescribed and recommended by the practitioner that would otherwise be utilized after 30 days.

Section2 resultsina cost to DSS associatedwithprinting andmailing notices to HUSKY Health members affected by a DSS decision to deny or suspend payment for a prescription drug or institute new step therapy or prior authorization requirements.

For context, there were approximately 674,200 pharmacy claims paid in June 2025.

If 10% of estimated annual claims require a notice, DSS would incur costs between $680,000 and $1.2 million depending on the number of pages required and associated postage rates.

The Out Years The annualized ongoing fiscal impact identified above would continue into the future subject to the duration of step therapy drugs utilized, notices required, and associated costs.

sSB331 / File No.

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462 OLR Bill Analysis sSB 331 AN ACT CONCERNING STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR IMPOSITION OF NEW REQUIREMENTS.

SUMMARY This bill changes the allowed duration for step therapy for Medicaid prescription drugs and sets notice requirements for HUSKY Health enrollees affected by decisions related to prescription drugs, step therapy, or prior authorization requirements.

Existing law allows the Department of Social Services (DSS) commissioner to establish a step therapy program for Medicaid prescription drugs.

Under this program, she may condition Medicaid payments on a requirement that the patient use a drug from the preferred drug list before any other prescribed drug, with certain exceptions.

Current law limits the duration of a step therapy requirement to 30 days, after which a practitioner may deem the drug clinically ineffective for the patient.

The bill allows DSS to impose a step therapy requirement for a period of time that adheres to evidence-based guidelines issued by the drug manufacturer and the FDA.