Public Health Committee
JOINT FAVORABLE REPORT
Bill No.: HB-5275
AN ACT PROHIBITING CERTAIN HEALTH CARRIERS FROM REQUIRING
STEP THERAPY FOR PRESCRIPTION DRUGS USED TO TREAT MENTAL OR
Title: BEHAVIORAL HEALTH CONDITIONS.
Vote Date: 3/18/2022
Vote Action: Joint Favorable
PH Date: 3/14/2022
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:
The Public Health Committee
REASONS FOR BILL:
Step therapy is the practice of using less expensive drugs for specific medical conditions
before using a higher cost medication to treat the condition. Individuals with behavioral health
diagnoses have complicated needs and accessing the appropriate medication should not be
overly complicated. This bill focuses on prohibiting an individual or group health insurance
policy from requiring this practice when treating individuals with mental of behavioral health
conditions.
RESPONSE FROM ADMINISTRATION/AGENCY:
Ted Doolittle, Office of the Healthcare Advocate, (OHA):
OHA supports the intent of the bill, which is to align patients with optimal therapeutic
protocols. But OHA cautions that step therapy as a tool to contain costs should not be
removed from the toolbox of the pharmaceutical industry. Instead, OHA recommends that a
more targeted approach eliminating step therapy only where the negative benefits of the
therapy outweigh the economic benefits.
Martin Looney, State Senator and President Pro Tempore, CGA
Sen Looney recommends that the bill language mirror that of SB 415, heard in the Insurance
and Real Estate Committee, which expands the limits of step therapy to include chronic,
disabling, or life-threatening diseases. Step therapy, while understandable from an economic
perspective, can be detrimental to a patient's treatment protocol.
Michelle Cook, Christy Carpino, State Representatives, CGA
Representatives Cook and Carpino believe that individuals with behavioral health needs
should not have to experience an overly complicated process to access the most beneficial
medications to treat their condition. The potential for adverse outcomes from using fewer
effective medications, including unnecessary trips to an emergency room or serious harm to
the individual, could have serious implications that negate the economic benefits from a less
costly medication.
NATURE AND SOURCES OF SUPPORT:
Connecticut State Medical Society (CSMS):
Health Insurers have many administrative hurdles in place that delay access to care and step
therapy is one of them. Step therapy can harm patient outcomes and create an obstacle to
successful treatment options. Questions as to why psychiatrists dont participate in some
health insurance networks can be answered by the administrative burdens of step therapy.
Sheldon Toubman, Litigation Attorney, Disability Rights CT:
Step therapy is a tool used by insurance companies to control costs. After a provider has
made their best educated guess on a medication therapy, the step therapy process becomes
very disruptive. The complexity of the step therapy process can impact communications
between the provider and the patient such that the provider is unaware the patient is not
getting his prescribed medication. Prohibiting step therapy will improve access to the
appropriate therapies for particularly vulnerable patients.
Mike Finley, Public Policy Coordinator, Mental Health CT:
This bill will be instrumental in improving access to critical mental and behavioral health
medications by prohibiting the fail first concept. Mental health treatments are individualized,
and providers prescribe medications based on individual situations. Applying step therapy
uniformly to all patient pharmaceutical orders negatively impacts the individual nature of the
therapy.
Other Testimony in support:
Thomas Burr, NAMI CT
Richard Crenshaw, PhD, APRN, CEO, Central CT Behavioral Health
Jordan Fairchild, Keep the Promise Coalition
NATURE AND SOURCES OF OPPOSITION:
Wyatt Bosworth, Assistant Counsel, Connecticut Business and Industry Association,
(CBIA):
CBIA has concerns regarding the potential cost increase to small and large group employer
health plans from the prohibition of step therapy. Step therapy has demonstrated a 10%
savings in targeted categories. The loss of savings would result in a significant increase in
Page 2 of 3 HB-5275
drug expenditures. There are enough protections in current law to protect consumers and
additional legislation is unnecessary.
Sam Hallemeier, Director State Affairs, Pharmaceutical Care Management Association,
(PCMA)
Our industry is concerned because the bill will restrict the ability to provide high quality benefit
and put downward pressure on the rising cost of prescription drugs. All plans have an
exception process that permits coverage of a drug not on formulary. Pharmacy Benefit
Managers (PBMs) employ Pharmacy and Therapeutic Committees that develop evidence-
based guidelines and assure cost controls do not impair the quality of care.
Reported by: David Rackliffe, Asst Clerk Date: March 30, 2022
Page 3 of 3 HB-5275


Statutes affected:
Raised Bill:
PH Joint Favorable:
File No. 294: