2019 Connecticut General Statutes
Title 38a - Insurance
Chapter 700c - Health Insurance
Section 38a-479ooo - (Note: This section is effective January 1, 2020.) Definitions.

For the purposes of this part:

(1) “Commissioner” means the Insurance Commissioner.

(2) “Department” means the Insurance Department.

(3) “Drug” has the same meaning as provided in section 21a-92.

(4) “Health care plan” means an individual or a group health insurance policy that provides coverage of the types specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 and includes coverage for outpatient prescription drugs.

(5) “Health carrier” means an insurance company, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues a health care plan in this state.

(6) “Person” has the same meaning as provided in section 38a-1.

(7) “Pharmacist” has the same meaning as provided in section 38a-479aaa.

(8) “Pharmacist services” has the same meaning as provided in section 38a-479aaa.

(9) “Pharmacy” has the same meaning as provided in section 38a-479aaa.

(10) “Pharmacy benefits manager” or “manager” means any person that administers the prescription drug, prescription device, pharmacist services or prescription drug and device and pharmacist services portion of a health care plan on behalf of a health carrier.

(11) (A) “Rebate” means a discount or concession, which affects the price of an outpatient prescription drug, that a pharmaceutical manufacturer directly provides to a (i) health carrier for an outpatient prescription drug manufactured by the pharmaceutical manufacturer, or (ii) pharmacy benefits manager after the manager processes a claim from a pharmacy or a pharmacist for an outpatient prescription drug manufactured by the pharmaceutical manufacturer.

(B) “Rebate” does not mean a bona fide service fee, as such term is defined in Section 447.502 of Title 42 of the Code of Federal Regulations, as amended from time to time.

(12) “Specialty drug” means a prescription outpatient specialty drug covered under the Medicare Part D program established pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as amended from time to time, that exceeds the specialty tier cost threshold established by the Centers for Medicare and Medicaid Services.

(P.A. 18-41, S. 1.)

History: P.A. 18-41 effective January 1, 2020.