Bill > SB00331

This bill modifies requirements for prescription drugs covered by the Medicaid program, which is a government health insurance program for low-income individuals and families. Firstly, it changes how "step therapy" works for prescription drugs. Step therapy is a process where a patient must try a less expensive drug first before their insurance will cover a more expensive one. This bill allows the duration of step therapy requirements to follow evidence-based guidelines from the drug manufacturer and the Food and Drug Administration (FDA), and if no such guidelines exist, step therapy may not last longer than thirty days. If a doctor determines the prescribed treatment is not working, the drug recommended by the doctor must be covered. Secondly, the bill mandates that the Department of Social Services, or any contracted entity managing pharmacy benefits, must provide clear written notice to HUSKY Health plan enrollees (a specific Medicaid managed care program) about any decisions to deny or suspend payment for a prescription drug, or when new step therapy or prior authorization requirements (which require pre-approval before a drug is covered) are imposed. This notice must be provided promptly, either at the pharmacy or by mail, and must explain the new requirements, how to comply, and the importance of discussing alternatives with their doctor, as well as information about their rights to appeal these decisions.

Health and Social Services

Human Services Committee (Joint)

https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=SB00331&which_year=2026