HB 6622 — AN ACT CONCERNING PRESCRIPTION DRUG FORMULARIES AND LISTS OF COVERED DRUGS.

House ofBill Representatives File No.

7536622 GeneralPublic AssemblyAct January Session, 2021(Reprint of File No.

348)21-96 HouseAN BillACT No.CONCERNING PRESCRIPTION DRUG FORMULARIES AND LISTS OF COVERED DRUGS.

6622 As Amended by House Amendment Schedule "A" Approved by the Legislative Commissioner May 27, 2021 AN ACT CONCERNING PRESCRIPTION DRUG FORMULARIES AND LISTS OF COVERED DRUGS.

HB6622(3) /"Annuities" Filemeans No.all agreements to make periodical payments where the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life or is for a specified term of years.

753This HB6622definition Filedoes not apply to payments made under a policy of life House Bill No.

7536622 (3)insurance. "Annuities" means all agreements to make periodical payments where the making or continuance of all or some of the series of the payments, or the amount of the payment, is dependent upon the continuance of human life or is for a specified term of years.

This definition does not apply to payments made under a policy of life insurance.

For purposes of this subdivision "liabilities" shall include but not HB6622be /limited Fileto reserves required by statute or by regulations adopted by the commissioner in accordance with the provisions of chapter 54 or specific requirements imposed by the commissioner upon a subject Public Act No.

75321-96 HB66222 Fileof 7 House Bill No.

7536622 be limited to reserves required by statute or by regulations adopted by the commissioner in accordance with the provisions of chapter 54 or specific requirements imposed by the commissioner upon a subject company at the time of admission or subsequent thereto.

(15) "Mutual insurer" means any insurer without capital stock, the HB6622Public /Act File No.

75321-96 HB66223 Fileof 7 House Bill No.

7536622 managing directors or officers of which are elected by its members.

(21) "United States" means the UnitedUnitedStates States of America, its territories and possessions, the Commonwealth of Puerto Rico and the District of Columbia.

(3) "Health benefit plan" has the same meaning as provided in section 38a-1080 of the general statutes, except that such term shall not include aPublic grandfatheredAct healthNo. plan as such term is used in the Affordable Care Act;

HB662221-96 /4 Fileof 7 House Bill No.

7536622 HB6622a Filegrandfathered No.health plan as such term is used in the Affordable Care Act;

753 (4) "Health carrier" has the same meaning as provided in section 38a- 1080 of the general statutes;

(1) Remove a prescription drug from the drug formulary or list of covered drugs, upon at least ninety days' advance notice to a covered personPublic andAct theNo. covered person's treating physician, if:

(A)21-96 The5 federal Food and Drug Administration issues an announcement, guidance, notice, warning or statement concerning the prescription drug that calls into question the clinical safety of the7 prescriptionHouse drug,Bill unless the covered person's treating physician states, HB6622 / File No.

7536622 HB6622person Fileand No.the covered person's treating physician, if:

753(A) The federal Food and Drug Administration issues an announcement, guidance, notice, warning or statement concerning the prescription drug that calls into question the clinical safety of the prescription drug, unless the covered person's treating physician states, in writing, that the prescription drug remains medically necessary despite such announcement, guidance, notice, warning or statement;

(e) (1) The Office of Health Strategy shall, at least annually, conduct a study to determine the impact that the requirements established in subsections (a) to (d), inclusive, of this section have on the cost of health benefit plans offered, delivered, issued for delivery, renewed, amended orPublic continuedAct inNo. this state and qualified health plans offered and sold through the exchange.

(2)21-96 Not6 later than January 31, 2023,and annually thereafter,the Office of Health7 StrategyHouse shallBill submitNo. a report, in accordance with the provisions of section 11-4a of the general statutes, to the commissioner and the joint standing committee of the General Assembly having cognizance of matters relating to insurance.

Such6622 reportor shallcontinued disclosein HB6622this /state Fileand No.qualified health plans offered and sold through the exchange.

753(2) HB6622Not Filelater No.than January 31, 2023,and annually thereafter, the Office of Health Strategy shall submit a report, in accordance with the provisions of section 11-4a of the general statutes, to the commissioner and the joint standing committee of the General Assembly having cognizance of matters relating to insurance.

753Such report shall disclose the results of the study conducted pursuant to subdivision (1) of this subsection for the preceding year.

ThisApproved actJune shall28, take2021 effectPublic asAct followsNo. and shall amend the following sections:

Section21-96 17 Januaryof 1,7 2022 38a-1 Sec.

2 January 1, 2022 New section HB6622 / File No.

753 7 HB6622 File No.

753 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:

None Municipal Impact:

Municipalities Effect FY 22 $ FY 23 $ Various Municipalities Potential See Below See Below Cost Explanation The bill as amended will not result in a fiscal impact to the state employee and retiree health plan.

The bill is not anticipated to materially modify the pharmacy benefit manager’s administration of the plan’s formulary compared to current practice given the $40 copay cap in the bill.

The bill as amended may increase costs to certain fully insured municipal plans to comply with the provisions of the bill if the plans are not otherwise excluded by the copay cap.