February 8, 2017

CT bill would limit changes to health plans' drug coverage

Two Connecticut legislators have introduced a bill that would guarantee individuals receive the prescription drug coverage they signed up for by limiting when insurer policies can change prescription drug formularies during the plan year.

The Middletown-based U.S. Pain Foundation, a nonprofit that lobbies for those who live with painful conditions, applauded the bill, HB 6622, introduced by Rep. Michelle L. Cook (D- Torrington) and Rep. Linda A. Orange (D-Colchester).

Connecticut does not prohibit health plans from changing contracted pharmacy benefits midyear, when individuals are locked into their plans. Insurers are increasingly taking advantage of the loophole to save on costs and, at any time, may increase out-of-pocket costs, enact more restrictions on coverage, or remove coverage of a prescription medication altogether, the foundation said in a news release.

These coverage reductions are often done to try to move a patient off of his or her current medication and onto an insurer-preferred drug, the foundation said. The practice is known as "non-medical switching" because patients are forced to switch for financial reasons, as opposed to medical ones.

HB 6622 would halt this practice by prohibiting insurers from making reductions to their prescription benefit plans for duration of the policy term, unless the drugs are deemed no longer safe and effective by the Food and Drug Administration or professional medical literature.

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