CT SB00025

Limits out-of-pocket expenses (coinsurance, copayments, deductibles) to a maximum of $100 per 30-day supply for covered prescription drugs in both individual and group health insurance policies, effective January 1, 2016.

Prohibits insurers from placing all drugs in a given class in the highest cost-sharing tier of tiered prescription drug formularies.

Restricts step therapy requirements to a maximum of 60 days, after which treating health care providers may deem the regimen clinically ineffective and insurers must authorize coverage for the prescribed drug.

Requires insurers using step therapy to establish a process allowing health care providers to request overrides at any time based on past ineffectiveness, expected ineffectiveness, adverse reactions, or medical necessity.

Exempts high deductible health plans from the $100 out-of-pocket limit until the plan's minimum annual deductible is met.