2022 Connecticut General Statutes
Title 38a - Insurance
Chapter 700c - Health Insurance
Section 38a-477cc. - Contracts for pharmacy services with health carriers or pharmacy benefits managers.
(a) No contract for pharmacy services entered into in the state between a health carrier, as defined in section 38a-591a, or pharmacy benefits manager, as defined in section 38a-479aaa, and a pharmacy or pharmacist shall:
(1) On and after January 1, 2018, contain a provision prohibiting or penalizing, including through increased utilization review, reduced payments or other financial disincentives, a pharmacist's disclosure to an individual purchasing prescription medication of information regarding:
(A) The cost of the prescription medication to the individual; or
(B) The availability of any therapeutically equivalent alternative medications or alternative methods of purchasing the prescription medication, including, but not limited to, paying a cash price, that are less expensive than the cost of the prescription medication to the individual; and
(2) On and after January 1, 2020, contain a provision permitting the health carrier or pharmacy benefits manager to recoup, directly or indirectly, from a pharmacy or pharmacist any portion of a claim that such health carrier or pharmacy benefits manager has paid to the pharmacy or pharmacist, unless such recoupment is permitted under section 38a-479iii or required by applicable law.
(b) (1) On and after January 1, 2018, no health carrier or pharmacy benefits manager shall require an individual to make a payment at the point of sale for a covered prescription medication in an amount greater than the lesser of:
(A) The applicable copayment for such prescription medication;
(B) The allowable claim amount for the prescription medication; or
(C) The amount an individual would pay for the prescription medication if the individual purchased the prescription medication without using a health benefit plan, as defined in section 38a-591a, or any other source of prescription medication benefits or discounts.
(2) For the purposes of this subsection, “allowable claim amount” means the amount the health carrier or pharmacy benefits manager has agreed to pay the pharmacy for the prescription medication.
(c) Any provision of a contract that violates the provisions of this section shall be void and unenforceable. Any general business practice that violates the provisions of this section shall constitute an unfair trade practice pursuant to chapter 735a. The invalidity or unenforceability of any contract provision under this subsection shall not affect any other provision of the contract.
(d) The Insurance Commissioner may:
(1) Enforce the provisions of this section pursuant to chapter 697; and
(2) Upon request, audit a contract for pharmacy services for compliance with the provisions of this section.
(P.A. 17-241, S. 1; P.A. 19-199, S. 1.)
History: P.A. 19-199 amended Subsec. (a) by deleting reference to January 1, 2018, designating existing provisions re contract for pharmacy services as new Subdiv. (1) and amending same by adding reference to January 1, 2018, redesignating existing Subdiv. (1) as Subpara. (A) and redesignating existing Subdiv. (2) as Subpara. (B), and adding new Subdiv. (2) re contract for pharmacy services on and after January 1, 2020, amended Subsec. (b) by designating existing provisions re payment at point of sale for prescription medication as new Subdiv. (1), redesignating existing Subdiv. (1) as Subpara. (A), redesignating existing Subdivs. (2) and (3) as Subparas. (B) and (C), and designating existing provision defining “allowable claim amount” as Subdiv. (2), and made technical and conforming changes.
