SB 182 — AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM REQUIRING STEP THERAPY FOR PRESCRIPTION DRUGS USED TO TREAT A MENTAL OR BEHAVIORAL HEALTH CONDITION OR A CHRONIC, DISABLING OR LIFE-THREATENING CONDITION.

Senate General Assembly RaisedFile Bill No.

18220 February Session, 2024 LCOSubstitute Senate Bill No.

1479182 ReferredSenate, toMarch 13, 2024 The Committee on PUBLICPublic HEALTHHealth Introducedreported by:through SEN.

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AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM REQUIRING STEP THERAPY FOR PRESCRIPTION DRUGS USED TO TREAT A MENTAL OR BEHAVIORAL HEALTH CONDITION OR A CHRONIC, DISABLING OR LIFE-THREATENING CONDITION.

or (2)sSB182 Require,/ ifFile such insurance company, hospital service corporation, LCO No.

147920 1 ofsSB182 6File RaisedNo. Bill No.182 medical service corporation, health care center or other entity uses step therapy for such drugs, the use of step therapy (A) for any prescribed drug for longer than thirty days, (B) for a prescribed drug for cancer treatment for an insured who has been diagnosed with stage IV metastatic cancer provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, [or] (C) for the period commencing January 1, 2024, and ending January 1, 2027, inclusive, for the treatment of schizophrenia, major depressive disorder or bipolar disorder, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders", (D) for the period commencing January 1, 2025, a prescribed drug for the treatment of a mental or behavioral health condition, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, or (E) for the period commencing January 1, 2025, a prescribed drug for the treatmentofa chronic, disabling or life-threatening conditionor disease, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

20 (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 (A) for any prescribed drug for longer than [thirty] twenty days, (B) for a prescribed drug for cancer treatment for an insured who has been diagnosed with stage IV metastatic cancer provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, [or] (C) for the period commencing January 1, 2024, and ending January 1, 2027, inclusive, for the treatment of schizophrenia, major depressive disorder or bipolar disorder, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders", (D) for the period commencing January 1, 2025, for a prescribed drug for the treatment of a mental or behavioral health condition, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, or (E) for the period commencing January 1, 2025, for a prescribed drug for the treatmentofa chronic, disabling or life-threatening conditionor disease, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications.

LCOsSB182 / File No.

147920 2 ofsSB182 6File RaisedNo. Bill No.182 (b) (1) Notwithstanding the [sixty-day] thirty-day period set forth in subparagraph (A) of subdivision (2) of subsection (a) of this section, each insurance company, hospital service corporation, medical service corporation, health care center or other entity that uses step therapy for such prescription drugs shall establish and disclose to its health care providers a process by which an insured's treating health care provider may request at any time an override of the use of any step therapy drug regimen.

20 (b) (1) Notwithstanding the [sixty-day] twenty-day period set forth in subparagraph (A) of subdivision (2) of subsection (a) of this section, each insurance company, hospital service corporation, medical service corporation, health care center or other entity that uses step therapy for such prescription drugs shall establish and disclose to its health care providers a process by which an insured's treating health care provider may request at any time an override of the use of any step therapy drug regimen.

(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 LCOinsurance policy or contract that provides coverage for prescription sSB182 / File No.

147920 3 ofsSB182 6File RaisedNo. Bill No.182 insurance policy or contract that provides coverage for prescription drugs may:

20 drugs may:

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 (A) for any prescribed drug for longer than thirty[thirty] twenty days, (B) for a prescribed drug for cancer treatment for an insured who has been diagnosed with stage IV metastatic cancer provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, [or] (C) for the period commencing January 1, 2024, and ending January 1, 2027, inclusive, for the treatment of schizophrenia, major depressive disorder or bipolar disorder, as defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders", (D) for the period commencing January 1, 2025, for a prescribed drug for the treatment of a mental or behavioral health condition, provided such prescribed drug is in compliance with approved federal Food and Drug Administration indications, or (E) for the period commencing January 1, 2025, for a prescribed drug for the treatmentofa chronic, disabling or life-threatening conditionor disease, 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), [or] (C), (D) or (E) of subdivision (2) of this subsection, an insured's treating health care provider may deem such step therapydrugregimenclinically ineffective for theinsured,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 LCOunder No.such policy or contract.

1479If 4such ofprovider 6does Raisednot Billdeem No.182such understep suchsSB182 policy/ orFile contract.No.

If20 such4 providersSB182 doesFile notNo. 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.

20 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.

(b) (1) Notwithstanding the [sixty-day] thirty-daytwenty-day period set forth in subparagraph (A) of subdivision (2) of subsection (a) of this section, each insurance company, hospital service corporation, medical service corporation, health care center or other entity that uses step therapy for such prescription drugs shall establish and disclose to its health care providers a process by which an insured's treating health care provider may request at any time an override of the use of any step therapy drug regimen.

LCOsSB182 / File No.

147920 5 ofsSB182 6File Raised Bill No.

18220 This act shall take effect as follows and shall amend the following sections:

2 January 1, 2025 38a-544 StatementPH ofJoint Purpose:Favorable Subst.

TosSB182 prohibit/ certainFile healthNo. carriers from requiring step therapy for prescription drugs used to treat a mental or behavioral health condition or a chronic, disabling or life-threatening condition.

[Proposed20 deletions6 aresSB182 enclosedFile inNo. brackets.

Proposed20 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.

1479In 6general, fiscal impacts are based upon a variety of 6informational 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 25 $ FY 26 $ State Comptroller - Fringe GF - Cost See Below See Below Benefits Note:

GF=General Fund Municipal Impact:

Municipalities Effect FY 25 $ FY 26 $ Various Municipalities STATE See Below See Below MANDATE 1 - Cost Explanation The bill, which eliminates a health carrier's use of step therapy, results in a cost to the State Comptroller - Fringe Benefits account annually dependent on claims data for the state employee health plan.

Step therapy is used as a cost management tool, and its prohibition for prescription drugs to treat a mental or behavioral health, chronic, disabling, or life-threatening condition or disease is likely to be reflected in higher premiums for the state employee health plan through an increased per member per month cost.

The conditions listed in the bill are associated with the highest claimants on the plans, whose claims are largely driven by prescription drug costs.

The elimination of step therapyfortheseconditions,aswellasthelowerstep therapymaximum time frame for all other conditions will result in a fiscal impact to the state, assuming an increase in claim costs.

1State mandate is defined in Sec.

2-32b(2) of the Connecticut General Statutes, "state mandate" means any state initiated constitutional, statutory or executive action that requires a local government to establish, expand or modify its activities in such a way as to necessitate additional expenditures from local revenues.

sSB182 / File No.

20 7 sSB182 File No.