§ 38a-591o — Restrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions.

(a) As used in this section: (1) “Brand name drug” means a drug that is produced or distributed in accordance with an original new drug application approved under 21 USC 355, as amended from time to time, but does not include a generic drug as defined in 42 CFR 447.502, as amended from time to time; (2) “Generic drug” means (A) a prescription drug product that is marketed or distributed in accordance with an abbreviated new drug application approved under 21 USC 355, as amended from time to time, (B) a generic drug as defined in 42 CFR 447.502, as amended from time to time, or (C) a drug that entered the market before calendar year 1962 that was not originally marketed under a new prescription drug product application; and (3) “Third-party administrator” has the same meaning as provided in section 38a-720 . (b) No health carrier shall require a prospective or concurrent review of a recurring prescription drug to directly treat any autoimmune disorder, multiple sclerosis or cancer after such health carrier has certified such prescription drug through utilization review. Nothing in this section shall require a health carrier to cover: (1) Any prescription drug to treat any autoimmune disorder, multiple sclerosis or cancer if the terms of coverage completely exclude such prescription drug from the policy's covered benefits; (2) a brand name drug when an equivalent generic drug is available; (3) a prescription drug that was certified through prospective or concurrent review (A) by such covered person's previous health carrier, or (B) under a previous employer's fully insured health plan administered by a third-party administrator that provided coverage to such covered person.

Legislative History

(P.A. 23-204, S. 221.) History: P.A. 23-204 effective January 1, 2025.