Connecticut General Statutes 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 § 38a-591a, or pharmacy benefits manager, as defined in § 38a-479aaa, and a pharmacy or pharmacist shall:
Terms Used In Connecticut General Statutes 38a-477cc
- Commissioner: means the Insurance Commissioner. See Connecticut General Statutes 38a-1
- Contract: A legal written agreement that becomes binding when signed.
- Insurance: means any agreement to pay a sum of money, provide services or any other thing of value on the happening of a particular event or contingency or to provide indemnity for loss in respect to a specified subject by specified perils in return for a consideration. See Connecticut General Statutes 38a-1
- State: means any state, district, or territory of the United States. See Connecticut General Statutes 38a-1
(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 § 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 § 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.