HB 6831 — AN ACT CONCERNING THE OVERRIDE OF STEP THERAPY FOR CERTAIN MENTAL HEALTH CONDITIONS AND ESTABLISHING A TASK FORCE TO STUDY DATA COLLECTION EFFORTS REGARDING STEP THERAPY.

House of Representatives General Assembly RaisedFile Bill No.

6831334 January Session, 2023 LCOSubstitute House Bill No.

31516831 ReferredHouse toof Representatives, March 30, 2023 The Committee on INSURANCEInsurance ANDand REALReal ESTATEEstate Introducedreported by:through REP.

(INS)WOOD ANof ACTthe CONCERNING29th THEDist., OVERRIDEChairperson OFof STEPthe THERAPYCommittee FORon CERTAINthe MENTALpart HEALTHof CONDITIONS.the House, that the substitute bill ought to pass.

AN ACT CONCERNING THE OVERRIDE OF STEP THERAPY FOR CERTAIN MENTAL HEALTH CONDITIONS AND ESTABLISHING A TASK FORCE TO STUDY DATA COLLECTION EFFORTS REGARDING STEP THERAPY.

Such disclosure shall be made to health care providers, in writing, not less than once each calendar year and such health care provider shall display in a conspicuoussHB6831 and/ prominentFile location,No. including the provider's Internet web site and on a bulletin board in the provider's office, information regarding the override process.

Any334 such1 overridesHB6831 processFile shall be LCO No.

3151334 1conspicuous of 5 Raised Bill No.6831 convenient to use by health care providers and anprominent overridelocation, requestincluding shall be expeditiously granted when an insured's treating health care provider demonstrates that the drugprovider's regimenInternet requiredweb undersite stepand therapy (A)has beenineffective inthepast for treatment oftheinsured's medical condition, (B) is expected to be ineffective based on thea knownbulletin relevantboard physicalin or mental characteristics of the insuredprovider's andoffice, theinformation knownregarding characteristics of the drugoverride regimen,process. (C) will cause or will likely cause an adverse reaction by or physical harm to the insured, or (D) is not in the best interest of the insured, based on medical necessity.

Any such override process shall be convenient to use by health care providers and an override request shall be expeditiously granted when an insured's treating health care provider demonstrates that the drug regimen required under step therapy (A)has beenineffective inthepast for treatment oftheinsured's medical condition, (B) is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and the known characteristics of the drug regimen, (C) will cause or will likely cause an adverse reaction by or physical harm to the insured, or (D) is not in the best interest of the insured, based on medical necessity.

Any such override process shall be convenient to use by health care providers and an override request shall besHB6831 expeditiously/ grantedFile when an insured's treating health care provider demonstrates that the drug regimen required under step therapy (A)has beenineffective inthepast for treatment oftheinsured's LCO No.

3151334 2 ofsHB6831 5File RaisedNo. Bill No.6831 medical condition, (B) is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and the known characteristics of the drug regimen, (C) will cause or will likely cause an adverse reaction by or physical harm to the insured, or (D) is not in the best interest of the insured, based on medical necessity.

334 be expeditiously granted when an insured's treating health care provider demonstrates that the drug regimen required under step therapy (A)has beenineffective inthepast for treatment oftheinsured's medical condition, (B) is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and the known characteristics of the drug regimen, (C) will cause or will likely cause an adverse reaction by or physical harm to the insured, or (D) is not in the best interest of the insured, based on medical necessity.

(1) One appointed by the speaker of the House of Representatives, who isshall be a health care provider with expertise in mental health;

(2) One appointed by the president pro tempore of the Senate, who isshall be a health care provider with expertise in mental health;

(3) One appointed by the minority leader of the House of Representatives, who isshall be a healthpharmacist carelicensed providerunder withchapter expertise400j inof mentalthe health;general statutes;

(4) One appointed by the minority leader of the Senate, who isshall be a healthrepresentative careof providerthe withpharmaceutical expertisemanufacturing inindustry; mental health;

(5) The chairpersons and ranking members of the joint standing committees of the General Assembly having cognizance of matters relatingsHB6831 to/ publicFile healthNo. and insurance, or their designees;

(6)334 The3 executivesHB6831 directorFile of the Office of Health Strategy, or the LCO No.

3151334 3relating ofto 5public Raisedhealth Billand No.6831insurance, executiveor director'stheir designee;designees;

(6) The executive director of the Office of Health Strategy, or the executive director's designee;

(c) TheAll administrativeinitial staffappointments ofto the jointtask standingforce committeeshall ofbe themade Generalnot Assemblylater havingthanthirty cognizancedaysafter oftheeffective mattersdate relatingofthis tosection.Any publicvacancy health shall servebe asfilled administrativeby staff of the taskappointing force.authority.

(d)NotlaterthanFebruary1,2024,thetaskforceshallsubmitareport(d) onThe itsspeaker findingsof andthe recommendationsHouse concerning subsection (a) of thisRepresentatives sectionand tothe thejointpresident standingpro committeesoftheGeneralAssemblytempore havingof cognizancethe ofSenate mattersshall relatingselect tothe insurancechairpersons andof publicthe health,task inforce accordancefrom withamong the provisionsmembers of section 11-4a of the generaltask statutes.force.

Such chairpersons shall schedule the first meeting of the task force, which shall be held not later than sixty days after the effective date of this section.

(e) The administrative staff of the joint standing committee of the sHB6831 / File No.

334 4 sHB6831 File No.

334 General Assembly having cognizance of matters relating to public health shall serve as administrative staff of the task force.

(f) Not later than February 1, 2024, the task force shall submit a report on its findings and recommendations concerning subsection (a) of this sectionto thejoint standing committeesoftheGeneralAssembly having cognizance of matters relating to insurance and public health, in accordance with the provisions of section 11-4a of the general statutes.

LCOThis No.act shall take effect as follows and shall amend the following sections:

3151 4 of 5 Raised Bill No.

6831 This act shall take effect as follows and shall amend the following sections:

3 from passage New section StatementINS ofJoint Purpose:Favorable Subst.

TosHB6831 (1)/ allowFile providersNo. to override step therapy for certain mental health conditions, and (2) establish a task force to study data collection efforts regarding step therapy.

[Proposed334 deletions5 aresHB6831 enclosedFile inNo. brackets.

Proposed334 additionsThe following Fiscal Impact Statement and Bill Analysis are indicatedprepared byfor underline,the exceptbenefit thatof whenthe members of the entireGeneral textAssembly, solely for purposes of ainformation, billsummarization orand resolutionexplanation orand ado sectionnot ofrepresent athe billintent orof resolutionthe isGeneral new,Assembly itor iseither notchamber underlined.]thereof LCOfor No.any purpose.

3151In 5general, fiscal impacts are based upon a variety of 5informational 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:

None Municipal Impact:

Municipalities Effect FY 24 $ FY 25 $ Various Municipalities Potential See Below See Below Cost Explanation The bill does not result in a fiscal impact to the state employee and retiree health plan or municipalities that participate in the Partnership Plan as step therapy is not required in the treatment of mental health conditionsoutlinedinthebill.Thesteptherapyoverrideprovisionsmay increase costs to certain fully insured municipal plans which currently require step therapy for treatment of schizophrenia, major depressive disorder, and bipolar disorder.

Section 3 establishes a task force to study data collection efforts regarding step therapy resulting in no fiscal impact to the state because the task force has the expertise to meet the requirements of the bill.