SB 1003 — AN ACT PROHIBITING CERTAIN HEALTH CARRIERS AND PHARMACY BENEFITS MANAGERS FROM EMPLOYING COPAY ACCUMULATOR PROGRAMS.

Senate GeneralBill Assembly File No.

3631003 JanuaryPublic Session,Act 2021 Senate Bill No.

100321-14 Senate,AN AprilACT 8,PROHIBITING 2021CERTAIN TheHEALTH CommitteeCARRIERS onAND InsurancePHARMACY andBENEFITS RealMANAGERS EstateFROM reportedEMPLOYING throughCOPAY SEN.ACCUMULATOR PROGRAMS.

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

AN ACT PROHIBITING CERTAIN HEALTH CARRIERS AND PHARMACY BENEFITS MANAGERS FROM EMPLOYING COPAY ACCUMULATOR PROGRAMS.

SB1003(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.

363This 1Senate SB1003Bill File No.

3631003 (3)definition "Annuities"does meansnot allapply agreements to make periodical payments wheremade theunder makinga orpolicy 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 orinsurance. 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 be limited to reserves required by statute or by regulations adopted by SB1003the /commissioner Filein accordance with the provisions of chapter 54 or Public Act No.

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3631003 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)Public "MutualAct insurer"No. means any insurer without capital stock, the managing directors or officers of which are elected by its members.

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3631003 3(15) SB1003"Mutual Fileinsurer" No.means any insurer without capital stock, the managing directors or officers of which are elected by its members.

363 (16) "Person" means an individual, a corporation, a partnership, a limited liability company, an association, a joint stock company, a business trust, an unincorporated organization or other legal entity.

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

(NEW) (Effective January 1, 2022) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues an individual or group health insurance policy in this state on or after January 1, 2022, providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes shall, when calculating an insured's liability for a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit, give credit for any paymentdiscount madeprovided by a third party for the amount of, or anypayment portionPublic ofAct theNo. amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit.

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1003 made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit.

SB1003As /used Filein No.this section, sections 38a-478a to 38a-478o, inclusive, [and] subsection (a) of section 38a-478s and section 4 of this act:

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363 As used in this section, sections 38a-478a to 38a-478o, inclusive, [and] subsection (a) of section 38a-478s and section 4 of this act:

(C) financial incentives for enrolleestousetheparticipatingprovidersandproceduresprovidedfor byPublic theAct plan;No.

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1003 by the plan;

(8) "Provider" or "health care provider" means a person licensed to SB1003provide /health Filecare No.services under chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, inclusive, or chapter 400j.

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363 provide health care services under chapters 370 to 373, inclusive, 375 to 383c, inclusive, 384a to 384c, inclusive, or chapter 400j.

(NEW) (Effective January 1, 2022) For any contract delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2022, each managed care organization shall, when calculating an enrollee's liability for a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit, give credit for any discount provided or payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit.

(NEW) (Effective January 1, 2022) On and after January 1, 2022, each contract entered into between a health carrier, as defined in section 38a-591a of the general statutes, and a pharmacy benefits manager, as defined in section 38a-479aaa of the general statutes, for the administration of the pharmacy benefit portion of a health benefit plan in this state on behalf of plan sponsors shall require that the pharmacy benefitsmanager,whencalculatinganinsured'sorenrollee'sliabilityforPublic acoinsurance,Act copayment,deductibleorotherout-of-pocketexpenseforNo. a covered prescription drug benefit, give credit for any payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered prescription drug benefit.

This21-14 act6 shallof take7 effectSenate asBill followsNo. and shall amend the following sections:

Section1003 1benefitsmanager,whencalculatinganinsured'sorenrollee'sliabilityfor Januaryacoinsurance, 1,copayment,deductibleorotherout-of-pocketexpensefor 2022a 38a-1covered Sec.prescription drug benefit, give credit for any discount provided or payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered prescription drug benefit.

2Approved JanuaryJune 1,2, 20222021 NewPublic sectionAct Sec.No.

321-14 January7 1,of 20227 38a-478 Sec.

4 January 1, 2022 New section SB1003 / File No.

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363 Sec.

5 January 1, 2022 New section INS Joint Favorable SB1003 / File No.

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