Insurance and Real Estate Committee
JOINT FAVORABLE REPORT
Bill No.: HB-6622
AN ACT CONCERNING PRESCRIPTION DRUG FORMULARIES AND LISTS
Title: OF COVERED DRUGS.
Vote Date: 3/22/2021
Vote Action: Joint Favorable
PH Date: 3/18/2021
File No.:
Disclaimer: The following JOINT FAVORABLE Report is prepared for the benefit of the
members of the General Assembly, solely for purposes of information, summarization and
explanation and does not represent the intent of the General Assembly or either chamber
thereof for any purpose.
SPONSORS OF BILL:
Rep. Jason Doucette, 13th Dist.
Rep. Michelle L. Cook, 65th Dist.
Sen. Martin M. Looney 11th Dist.
Sen. Saud Anwar, 3rd Dist.
REASONS FOR BILL:
The bill will limit the carriers' ability to remove safe and effective drugs from their formularies
in the middle of the plan year and shift a safe and effective drug to a higher cost tier during
the plan year. This bill protects patients from formulary changes during their insurance policy
terms. I
RESPONSE FROM ADMINISTRATION/AGENCY:
Ted Doolittle, Office of the Healthcare Advocate is in favor of the bill. Under current law
healthcare insurers may add or remove drugs from their formularies or shift individual drugs
between coverage tiers any time during a plan year. Consumers can be negatively impacted
when these changes occur in the middle of the plan year. Consumers spend substantial time
and energy reviewing and comparing plans to select and enroll in the coverage that best suits
their individual health care and prescription drug needs. When mid-year formulary changes
occur consumers often cannot absorb the resulting increases in cost and the
financial burden can result in negative medical consequences. This bill will impose
reasonable limitations on permissible modifications. The bill will limit the carriers' ability to
remove safe and effective drugs from their formularies in the middle of the plan year and shift
a safe and effective drug to a higher cost tier during the plan year. Carriers will still have great
flexibility to modify their prescriptions.
NATURE AND SOURCES OF SUPPORT:
Senator Martin M. Looney expressed support for the bill. This bill protects patients from
formulary changes during their insurance policy terms. It is unfair for a patient to purchase an
insurance policy and to have that policy change prescription formulary during the
policy. When a physician and a patient choose a drug it may have some dangerous side
effects but despite these danger it appears to be the best course of treatment. An insurer
could contact a physician to share any safety concerns rather than denying coverage as a
first step. I support the variety of coverage requirements as well as patient protections
regarding ambulance billing. I applaud the language in this bill.
AARP testified that under current law there is little to stop a health insurance provider from
marketing a plan as providing expansive coverage and then changing the benefit package
once an individual has enrolled. Health insurance providers should be held to the drug
formulary it markets to consumers. States with current policies relating to limiting nonmedical
switching include: California, Illinois, Louisiana, Maryland, Nevada, New Mexico Texas,
Indiana, Maine and Rhode Island. In 2019 AARP conducted a survey and 80% of older
voters take at least one prescription on a regular basis and 72% say they are concerned
about the cost and rely on their health insurance to help them access the medications they
need.
Kathy Flaherty, Executive Director, Connecticut Legal Rights Project stated that people
choose their health plans based on coverage of prescription drugs. It is unfair for a health
insurance company to change the tiers of drug coverage in the middle of a plan year.
Connecticut State Medical Society believes that this bill will help solve a long-standing
problem. Patients choose insurance plans based on several factors and one is having their
medication at an affordable price. When these changes are made during the plan year it may
leave a patient without a suitable alternative or a higher cost. The Global Healthy Living
Foundation in 2016 surveyed patients in Florida about these changes. Sixty eight percent of
those with chronic conditions said when the insurer reduced their coverage they were forced
to switch to a different medication, they could not afford the increased cost. Fifty eight
percent reported that the new medication was less effective.
Ruth Canovi, American Lung Association's Director of Advocacy appreciates this
bill. Lung disease patients having an affordable and quality healthcare is a main
priority. Clinical care for lung disease patients should follow evidence-based guidelines and
coverage restrictions mid-year can impede access to guidelines-based care. Patients need
to be able to receive medication and treatments that are best for them and to delay or
discontinue treatment may lead to higher health care costs.
Laura Hoch, National Multiple Sclerosis Society encourages the committee to amend the
bill to require insurers provide notice if they plan to remove a drug at the end of the policy
term. The notice given before open enrollment gives the insured the ability to make informed
decisions before enrollment. MS is often a disabling disease of the central nervous system
that vary from person to person. Nearly 1 million people in the United States are living with
MS and rely on their disease-modifying therapy medication (DMT). Non-medical switching
can be made by insurers during a patient's plan year. Movement from one DMT to
another should only occur for medical reasons and not because the insurance plan has
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changed. Inference with a person's course of treatment poses dangerous threats to their
health and safety.
Universal Healthcare Foundation of Connecticut expressed support of the bill. The bill
stops negative changes to private health insurer's prescription during a plan year and permits
positive changes. Individuals as well as employers choose a health plan that meets their
needs and those of their family. In a 2019 study by the Alliance for Patient Access found:
1. Nearly 40% of patients found new medication not as effective
2. Almost 60% experienced complications from the new medication
3. Nearly one in 10 reported being hospitalized from complications
4. Two-thirds of respondents said the switch impacted their productivity at work
5. More than 40% were unable to care for their children, spouses or family members
Forty percent of Connecticut residents were worried they would unable to afford medication
and 19 percent said they did not fill a prescription, cut pills in half and skipped a dose
because of the cost.
A similar bill passed the house in 2019 with significant bipartisan support and then in 2020
but died because of the legislative recess caused by COVID-19.
Yale Dems, Josh Guo and Grace Wittington submitted testimony in support. Citizens of
Connecticut rely on constant and consistent access to their medication. No person should
face obstacles when obtaining healthcare due to a sudden mid-year cost switch by their for-
profit insurer. Connecticut is already behind the curve. Several states like Texas have
passed similar laws eliminating mid-year formulary changes.
Peter Swartz testified as a multiple sclerosis neuropathy and transverse myelitis patient
needs this bill. The practice of non-medical switching is not right. This happened to me
when I was on a drug for 13 years and then suddenly during a plan year my insurer removed
this medication and told my doctor that I had to take a different medication. This medication
had not previously worked in the past and I had to take 5 more capsules a day. When
patients enroll in a plan they expect the insurers to live up to their contract.
Pamela Greenberg testified about her personal MS condition and medication. I rely on
several medication and send a large amount of money on co-pays to control my condition. I
have had my medications switched several times in the past. They have switched me from a
tier 2 to a tier 4 without notice at an increase in price from $30 a month to $125 a month.
Insurance companies should be made to stick to the contracts people signed up for.
Lauren LeClaire, Kennedy Bennett, Patrick Feeley ,Sarah McKinnis and Evan
Roberts sent similar testimony supporting the bill. Connecticut is already behind the curve
and needs to catch up with the rest of the nation on this issue
NATURE AND SOURCES OF OPPOSITION:
The Connecticut Association of Health Plans testified against the bill. State law already
requires coverage for a drug in an insurer is using the drug for a chronic illness. There are
strict step-therapy standards included in state statue. This is just one of
many pharmaceutical bills we are opposing. Pharmaceutical prices increase premiums
between 15% and 20% yearly. Connecticut's authority only applies to the fully-insured
market.
Page 3 of 4 HB-6622
Pharmaceutical Care Management Association thinks this bill would restrict their ability to
make drug coverage more affordable. Restricting the ability to make formulary changes will
increase health care costs for employers and individuals thru higher premiums and drug
costs. This type of policy world cost health care payers $70 million over 5 years.
Reported by: Pamela Bianca April 8, 2021
Page 4 of 4 HB-6622


Statutes affected:
Raised Bill:
INS Joint Favorable:
File No. 348:
File No. 753:
Public Act No. 21-96: