SB 36 — AN ACT PROHIBITING HEALTH CARRIERS FROM REQUIRING THE USE OF STEP THERAPY FOR DRUGS PRESCRIBED TO TREAT DISABLING, CHRONIC OR LIFE-THREATENING DISEASES OR CONDITIONS.

General Assembly ProposedCommittee Bill No.

9195482 Referred to Committee on INSURANCE AND REAL ESTATE Introduced by:

SEN.(INS) AN ACT PROHIBITING HEALTH CARRIERS FROM REQUIRING THE USE OF STEP THERAPY FOR DRUGS PRESCRIBED TO TREAT DISABLING, CHRONIC OR LIFE-THREATENING DISEASES OR CONDITIONS.

LOONEY, 11th Dist.

AN ACT PROHIBITING HEALTH CARRIERS FROM REQUIRING THE USE OF STEP THERAPY FOR CERTAIN PRESCRIPTION DRUGS.

ThatSection sections1. 38a-510 and 38a-544 of the general statutes be amended to prohibit health carriers that deliver, issue for delivery, renew, amend or continue health insurance policies and contracts in this state that provide coverage for prescription drugs from requiring the use of step therapy for a prescription drug if such drug is prescribed for the treatment of a disabling, chronic or life-threatening disease or condition.

StatementSubsection (a) of Purpose:section 38a-510 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2020):

To(a) prohibitNo healthinsurance carrierscompany, thathospital deliver,service issuecorporation, formedical delivery,service renew,corporation, amend or continue certain health insurancecare policiescenter andor contractsother inentity thisdelivering, stateissuing fromfor requiringdelivery, therenewing, useamending ofor stepcontinuing therapyan forindividual ahealth prescriptioninsurance drugpolicy ifor suchcontract drugthat isprovides prescribedcoverage for theprescription treatmentdrugs ofmay: a disabling, chronic or life-threatening disease or condition.

(1) Require any person covered under such policy or contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for such drugs;

or (2) Require, if such insurance company, hospital service corporation, medical service corporation, health care center or other entity uses step LCO No.

5482 1 of 4 Committee Bill No.36 therapy for such drugs, the use of step therapy for:

(A) [any] Any prescribed drug for longer than sixty days;

[,] or (B) [a] A prescribed drug for [cancer] treatment of a disabling, chronic or life-threatening disease or condition for an insured who has been diagnosed with [stage IV metastatic cancer] such a disease or condition, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

(3) At the expiration of the time period specified in subparagraph (A) of subdivision (2) of this subsection, [or for a prescribed drug described in subparagraph (B) of subdivision (2) of this subsection,] an insured's treating health care provider may deem such step therapy drug regimen clinically ineffective for the insured, at which time the insurance company, hospital service corporation, medical service corporation, health care center or other entity shall authorize dispensation of and coverage for the drug prescribed by the insured's treating health care provider, provided such drug is a covered drug under such policy or contract.

If such provider does not deem such step therapy drug regimen clinically ineffective or has not requested an override pursuant to subdivision (1) of subsection (b) of this section, such drug regimen may be continued.

For purposes of this section, "step therapy" means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are to be prescribed.

Sec.

2.

Subsection (a) of section 38a-544 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2020):

(a) No insurance company, hospital service corporation, medical service corporation, health care center or other entity delivering, issuing for delivery, renewing, amending or continuing a group health insurance policy or contract that provides coverage for prescription drugs may:

9195482 12 of 14 Committee Bill No.36 (1) Require any person covered under such policy or contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for such drugs;

or (2) Require, if such insurance company, hospital service corporation, medical service corporation, health care center or other entity uses step therapy for such drugs, the use of step therapy for:

(A) [any] Any prescribed drug for longer than sixty days;

[,] or (B) [a] A prescribed drug for [cancer] treatment of a disabling, chronic or life-threatening disease or condition for an insured who has been diagnosed with [stage IV metastatic cancer] such a disease or condition, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

(3) At the expiration of the time period specified in subparagraph (A) of subdivision (2) of this subsection, [or for a prescribed drug described in subparagraph (B) of subdivision (2) of this subsection,] an insured's treating health care provider may deem such step therapy drug regimen clinically ineffective for the insured, at which time the insurance company, hospital service corporation, medical service corporation, health care center or other entity shall authorize dispensation of and coverage for the drug prescribed by the insured's treating health care provider, provided such drug is a covered drug under such policy or contract.

If such provider does not deem such step therapy drug regimen clinically ineffective or has not requested an override pursuant to subdivision (1) of subsection (b) of this section, such drug regimen may be continued.

For purposes of this section, "step therapy" means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition are to be prescribed.

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

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36 Section 1 January 1, 2020 38a-510(a) Sec.

2 January 1, 2020 38a-544(a) Statement of Purpose:

To prohibit health carriers from requiring the use of step therapy for drugs prescribed to treat disabling, chronic or life-threatening diseases or conditions.

[Proposed deletions are enclosed in brackets.

Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.] Co-Sponsors:

SEN.

LOONEY, 11th Dist.

S.B.

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