CT SB00925

Health carriers must offer health insurance policies incorporating value-based insurance design for prescription drug benefits, considering outpatient services that are cost-effective, preventive, and likely to prevent hospitalization or emergency services.

Group health insurance policies requiring coinsurance or deductibles for prescription drugs must calculate these payments based on the actual net drug cost or an estimate based on recent historical data.

Health carrier contracts with healthcare providers reimbursing for prescription drug costs must separately reimburse for the drug cost, administration cost, and overhead costs, with administration and overhead costs not set as a fixed percentage of drug cost.

Manufacturers must notify the Insurance Commissioner within 60 days when selling a brand name drug with initial annual wholesale acquisition cost of $30,000 or greater, or a generic drug of $3,000 or greater, or when increasing prices by more than 10% or $10,000 (brand name) or 25% or $300 (generic).

Manufacturers must submit annual reports to the Insurance Commissioner disclosing the value of all price concessions provided to pharmacy benefits managers, expressed as a percentage of wholesale acquisition cost.

A task force is established to study value-based pricing of prescription drugs and recommend criteria for determining reasonable drug costs, with findings due to the insurance committee by February 1, 2018.