Connecticut Senate Democrats have introduced priority bills to improve patient protections in health insurance, prevent profit-seeking by insurers, and to reduce prescription drug costs through new strategies in acquisition.
“Onerous insurance company burdens and the ever-increasing cost of prescription drugs are a constant thorn in the side of consumers, and we must do our utmost in the General Assembly to contain these where we can,” said Senate President Martin M. Looney.
The health insurance bill, Senate Bill 10, involves several health insurance issues that have drawn attention from residents in recent years. A prominent piece of its intended changes regards mental health parity enforcement.
While Connecticut passed a law in 2019 to improve mental health access parity, its implementation has been slow, which has negatively impacted patient care; as many as four of seven major insurance providers aren’t meeting compliance, Senate leaders said. The proposed bill would establish penalties for insurance companies not complying with legal requirements for parity on mental health and substance use disorder.
The bill further prohibits automated “downcoding,” where an insurance company pays for a lower level of care than what doctors order or provide. This practice is often done using algorithms or artificial intelligence., Senate Democrats seek to require mandatory human review for downcoding recommendations.
Additionally, the legislation seeks to impose restrictions on use of “step therapy,” where a company requires a patient to utilize lower-cost, lower-efficacy procedures or drugs to address a medical issue. This practice can delay effective patient care, especially in cases of degenerative chronic disease. The legislation would update state laws to reduce step therapy requirements from 60 to 30 days and places stricter controls on drugs used to treat schizophrenia, major depressive disorder or bipolar disorder.
“Connecticut has a responsibility to step in where it can and level the playing field when it comes to these patient/insurance company relationships,” said Sen. Cabrera, Senate chair of the Insurance and Real Estate Committee.
The prescription drug bill comes on top of efforts in recent years by Connecticut Democrats to cap the cost of insulin at $25, allowing pharmacists to prescribe birth control and joining the ArrayRX discount drug program, all of which have benefitted residents of the state.
Building on those policies, Senate Bill 11 would specifically address pharmacy benefit managers, who administer prescriptions or services of health benefit plans on behalf of plan sponsors. PBMs can increase costs throughout the system; in Connecticut, three represent nearly two-thirds of the market and five cover 19 of every 20 residents.
The bill would require PBMs to pass along savings to plan sponsors and reform their fee structures to reduce costs.
The bill also seeks to pool state agencies’ buying power to reduce costs of acquiring prescription drugs, require care providers to reinvest 80% of revenue in nursing homes back into patient care and expand the definition of “emergency services” to better support state Medicaid coverage.
“Prescription drug costs are absolutely unsustainable and there is a strong, bipartisan coalition ready to tackle this incredibly complex issue,” said Sen. Matt Lesser, co-chair of the Human Services Committee and chair of the bipartisan Prescription Drug Task Force. “This is tough but important work and it is essential that we center the voices of perspectives of Connecticut patients.”
