Connecticut is a state to watch on healthcare cost and competition. Connecticut Attorney General George Jepsen has been particularly active in the past years in promoting fairness and transparency in healthcare pricing, as well as in promoting greater enforcement of provider consolidation.
In 2018, Connecticut was active in introducing legislation aimed at controlling pharmaceutical costs. The legislature passed HB 5384, which requires pharmaceutical companies to disclose and explain prescription drug price hikes. Drug makers must justify any pharmaceutical price that jumps 20 percent or more during a calendar year, insurers must report large drug cost increases when filing rate requests, and PBMs must report how much they collect in rebates and how much they keep. Additionally, the state passed SB 197, which adds biological products to existing laws regarding substitution of generic drugs.
Connecticut’s most recent legislative session ran from 2/6/2018 – 5/9/2018.
Recent Legislative Developments
|2018||HB5384||PRESCRIPTION DRUG COSTS: Concerns prescription drug costs, imposes additional disclosure and reporting requirements on pharmacy benefits managers, health carriers, pharmaceutical manufacturers, the Office of Health Strategy and the Insurance Department concerning prescription drug rebates and the cost of prescription drugs.||Passed – Signed by the Governor 5/31/2018.|
|2017||SB445||PHARMACEUTICAL PRICE TRANSPARENCY AND DISCLOSURE: No contract entered into in the state between a health carrier, pharmacy benefits manager, or any other entity and a pharmacist shall contain a provision prohibiting the pharmacist from disclosing any relevant information to an individual purchasing prescription medication.||Passed.|
|2015-2016||SB00815||ESTABLISHING A COMMISSION ON HEALTH CARE POLICY, COST CONTAINMENT, AND PRICE VARIATION: would establish a Commission on Health care Policy and Cost Containment—an independent administrative commission that is not subject to the supervision or control of any other executive officer or agency. The commission would be tasked with various responsibilities, including, but not limited to: (i) enhancing the transparency of provider organizations; (ii) monitoring and reviewing the impact of changes within the health care marketplace; (iii) reviewing variation in prices and insurance reimbursement rates among health care providers; (iv) holding public hearings, at least once a year, to examine health care provider, provider organization, and health insurance carrier costs, prices, trends, and cost trends and the factors that contribute to them; and (v) ensuring the uniform reporting of revenues, charges, costs, prices, and utilization of health services.||Inactive – Died.|
|CONSUMER HEALTH INFORMATION WEBSITE: the state exchange would be required to establish a consumer health information website containing information that compares the quality, price, and cost of health care services, including: (i) comparative price and cost information for the most common referrals or prescribed services; (ii) comparative quality information for which comparative price and cost information is provided; (iii) data concerning health care-associated infections and serious reportable events; (iv) definitions of common health insurance and medical terms; (v) a list of health care provider types; (vi) factors consumers should consider when choosing an insurance product or provider group; (vii) patient decision aids; (viii) a list of provider services accessible to people with disabilities; and (ix) descriptions of standard quality measures. The Insurance Commissioner and the Commissioner of Public Health would be required to, on an annual basis, report and make available on their websites: (i) the 100 most frequently provided inpatient admissions in the state; (ii) the 100 most frequently provided outpatient procedures performed in the state; (iii) the 25 most frequent surgical procured performed in he state; and (iv) the 25 most frequent imaging procedures performed in the state. These lists would also need to include bundled episodes of care. Once determined, each health carrier would be required, on an annual basis, (i) allowed amounts paid to each health care provider for each admission and procedure included in the report (above) and (ii) out-of-pocket costs for each admission and procedure. Additionally, each hospital and outpatient surgical facility would be required to, on an annual basis, report: (i) the amount to be charged to a patient for each admission ad procedure required in he report (above); (ii) the average negotiated settlement on the amount to be charged; (iii) the amount of Medicaid reimbursement for each admission or procedure; (iv) the amount of Medicare reimbursement for each admission or procedure; and (v) the five largest health carriers according to the previous year’s patient volume and the allowed amount for each admission or procedure. In addition, on and after October 1, 2015, no contract entered into, or renewed, between a health care provider and a health carrier shall contain a provision prohibiting disclosure of negotiated pricing information, including, but not limited to, pricing information relating to out-of-pocket expenses. Additionally, each health carrier would be required to develop and publish an Internet web site and institute the use of a mobile device application and toll-free telephone number to enable consumers to request and obtain: (1) Information on in-network costs for inpatient admissions, health care procedures and services, including (A) the allowed amount for (i) at a minimum, admissions and procedures reported to the Connecticut Health Insurance Exchange pursuant to section 2 of this act for each health care provider in the state, and (ii) prescribed drugs and durable medical equipment; (B) the estimated out-of-pocket cost that the consumer would be responsible for paying for any such admission or procedure that is medically necessary, including any facility fee, copayment, deductible, coinsurance or other expense; and (C) data or other information concerning (i) quality measures for the health care provider, as such measures are determined by the Commissioner of Public Health in accordance with subsection (g) of section 2 of this act, (ii) patient satisfaction, (iii) whether a health care provider is accepting new patients, (iv) credentials of health care providers, (v) languages spoken by health care providers, and (vi) network status of health care providers; and (2) information on out-of-network costs for inpatient admissions, health care procedures and services.||Inactive – Died.|
|AN ACT CONCERNING DISCLOSURE OF FACILITY FEES TO PATIENTS: would require hospitals and hospital-based facilities to disclose to each patient, in writing, prior to providing services to a patient, a detailed explanation of any facility fee, including the total fee and the patient’s potential out-of-pocket cost after applying any insurance coverage or other reimbursement.||Inactive – Died.|
|2018||HB5209||LONG TERM CARE INSURANCE PREMIUM RATE INCREASE: To require insurers that file a rate increase of twenty per cent or more for an individual or a group long-term care insurance policy to spread such increase over not less than five years.||Inactive/Dead.|
|HB5039||PROTECTING HEALTH CARE FAIRNESS AND AFFORDABILITY: Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall, at a minimum, provide coverage, and not impose any cost-sharing requirements. Any applicable individual who fails to maintain minimum essential coverage for one or more months in any taxable year shall be subject to a penalty for each month that such individual fails to maintain minimum essential coverage. The monthly penalty amount shall be one-twelfth of the greater of five hundred dollars or two per cent of such individual’s properly reported Connecticut adjusted gross income.||Inactive/Dead.|
|HB5385||AN ACT ESTABLISHING A WORKING GROUP TO STUDY HEALTH INSURANCE PREMIUM RATE INCREASES AND DEVELOP RECOMMENDATIONS TO MITIGATE SUCH INCREASES: To establish a working group to study health insurance premium rate increases and develop recommendations to mitigate such increases.||Inactive/Dead.|
|2017||SB442||PREDATORY PRICING OF PHARMACEUTICALS: amend the general statues to make predatory pricing of pharmaceuticals an unfair trade practice.||Inactive – Died.|
|SB544||PRIOR LEGISLATIVE APPROVAL OF INCREASES IN ASSESSMENTS AND USER FEES CHARGED BY THE CONNECTICUT HEALTH INSURANCE EXCHANGE: Allows the Connecticut Health Insurance Exchange (i.e., Access Health CT), only with the prior approval of the Insurance and Real Estate Committee, to (1) increase health carrier assessments or user fees or (2) change the methodology used to calculate assessments or user fees. By law, the exchange can charge health carriers capable of offering qualified health plans through the exchange assessments or user fees to fund the exchange’s operations. Under the bill, the exchange must submit any proposed increase in assessments or user fees or change in calculation methodology to the Insurance and Real Estate Committee. If the committee does not take action within 60 days after receiving a proposal, the increase or methodology change is deemed to be denied.||Inactive – Died.|
|HB6688||CONCERNING PROVIDER PAYMENT ARRANGEMENTS WITH HEALTH CARRIERS: Requires health carriers to accept any provider payment arrangement without instituting any additional requirements for the provider to participate in other programs or networks.||Inactive – Died.|
|HB7042||CONTROLLING CONSUMER HEALTH COSTS: This bill modifies the Insurance Department’s mandated health benefit review program. It prohibits the General Assembly, beginning February 1, 2018, from enacting any legislation mandating insurers to cover a new health benefit unless the benefit has been the subject of (1) a health benefit review report by the department and (2) an informational hearing before the Insurance and Real Estate and Public Health committees at which the commissioner is present and available for questions. The bill authorizes the Insurance and Real Estate Committee, during a regular legislative session and by a majority vote of the committee members, to require the insurance commissioner to review and report on up to five proposed mandated health benefits. Under current law, the committee may request a review from the commissioner by August 1 of each year.||Inactive – Died.|
|2018||SB197||BIOLOGICAL PRODUCTS: Concerns biological products, adds biological products to existing law regarding substitution of generic drugs. Requires that within 48-hours of dispensing ”the pharmacist shall inform the prescribing practitioner by facsimile, telephone or electronic transmission of the biosimilar substitution.||Passed –Signed by the Governor on 6/4/18.|
|SB379||LIMITING CHANGES TO HEALTH INSURERS’ PRESCRIPTION DRUG FORMULARIES: Limits changes to health insurers’ prescription drug formularies, limits when an insurer may change prescription drug formularies during the term of certain group and individual health insurance policies.||Inactive/Dead.|
|HB5210||INSURANCE COVERAGE OF ESSENTIAL HEALTH BENEFITS: Mandates insurance coverage of essential health benefits and expanding mandated health benefits for women, children and adolescents, mandates insurance coverage of essential health benefits, expands mandated health benefits for women, children and adolescents, expands mandated contraception benefits.||Passed – Signed by the Governor on 5/25/18.|
|HB5114||CONCERNING MANDATORY HEALTH INSURANCE COVERAGE, ESTABLISHING AN AFFORDABLE HEALTH CARE FUND AND A TASK FORCE TO DEVELOP A REINSURANCE PROGRAM TO SEEK A STATE INNOVATION WAIVER: To establish an individual mandate and accompanying tax penalty, an Affordable Health Care Fund, a comprehensive health insurance coverage verification program and a task force to develop a reinsurance program that will enable the state to seek a “State Innovation Waiver”.||Inactive/Dead.|
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Gen. Stat § 17-241 beginning on October 2017, no contract entered into between a health care provider, or any agent or vendor retained by the health care provider to provide data or analytical services to evaluate and manage health care services provided to the health carrier’s plan participants, and a health carrier shall contain a provision prohibiting disclosure of (1) billed or allowed amounts, reimbursement rates or out-of-pocket costs, or (2) any data to the all-payer claims database program established under section 38a-1091. Information described in subdivisions (1) and (2) of this subsection may be used to assist consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and allow comparisons between prices paid by various health carriers to health care providers.
- Conn. Gen. Stat§ 368z governs the Office of Health Care Access, whose powers include: (1) authorizing and overseeing the collection of health data; (2) overseeing and coordinating health system planning for the state; (3) monitoring health care costs; and (4) implementing and overseeing health care reform as enacted by the General Assembly.
- Conn. Gen. Stat § 19a-724 established an All-Payer Claims Database in 2012.
- HB 5384 (citation to Conn. Gen. Stat. pending) imposes additional disclosure and reporting requirements on pharmacy benefits managers, health carriers, pharmaceutical manufacturers, the Office of Health Strategy, and the Insurance Department concerning prescription drug rebates and the cost of prescription drugs.
- The Connecticut Antitrust Act contains provisions under which (often in addition to federal statutes), the state or private persons may bring claims.
- Connecticut has a robust process for requiring and evaluating requests for certificates of need. The state’s Certificate of Need Program is detailed on the department of health’s website.
- SB 197 (citation to Conn. Gen. Stat. pending) adds biological products to existing law regarding substation of generic drugs.
2018 – 2019 BUDGET
Connecticut enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year. Connecticut’s new Biennial Budget will take effect on July 1, 2017 and is valid through June 30, 2019. Connecticut has not enacted its 2018-2019 budget. To view Connecticut’s most recent 2018-2019 Budget proposal, click here.
- In June 2012, AG Jepsen, in coordination with the FTC, declined to challenge the proposed merger of Yale-New Haven Hospital and The Hospital of Saint Raphael. The enforcement entities apparently based their decision, in part, on St. Raphael’s precarious financial condition at the time of the deal.