CT HB05361

Effective January 1, 2021, health carriers offering pharmacy benefits in Connecticut are generally prohibited from removing prescription drugs from formularies or moving drugs to higher cost-sharing tiers during a plan year.

Health carriers may remove a drug from formulary with 90 days' advance notice to the covered person and treating physician if the FDA issues a safety warning unless the physician certifies in writing that the drug remains medically necessary, or if the drug becomes available over-the-counter.

Health carriers may move a brand-name drug to a higher cost-sharing tier if they simultaneously add a generic alternative to a lower cost-sharing tier.

The prohibition on mid-year formulary changes does not apply if the current cost-sharing requirement is $40 or less per prescription per month across all tiers.

Health carriers may add new drugs to formularies at any time during the plan year.