CT HB05517

Caps out-of-pocket expenses for prescription drugs at $100 per 30-day supply for covered drugs, except high deductible health plans are exempt from deductible caps until minimum annual deductible is met.

Prohibits insurers from requiring mail order pharmacy use as a condition of obtaining prescription drug benefits.

Prohibits placing all prescription drugs in a given class in the highest cost-sharing tier of a tiered formulary.

Limits step therapy use to 60 days, after which providers may deem regimen clinically ineffective and insurers must cover the prescribed drug; allows providers to request step therapy overrides at any time for clinical reasons.

Applies to both individual health insurance policies (Section 38a-510) and group health insurance policies (Section 38a-544), effective January 1, 2017.