SB00331 • 2026

AN ACT CONCERNING STEP THERAPY REQUIREMENTS FOR PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR IMPOSITION OF NEW REQUIREMENTS.

Children

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Human Services Committee
Last action: 2026-04-27
Official status: Favorable Report, Tabled for the Calendar, Senate
Effective date: Not listed

Plain English Breakdown

The official text confirms all notice timelines and step therapy limits stated in the candidate explanation.

Medicaid Step Therapy and Drug Denial Notice Rules

This law allows step therapy for Medicaid drugs to follow manufacturer or FDA guidelines, limits it to thirty days if no guidelines exist, and requires written notices when drug payments are denied, suspended, or new rules start.

What This Bill Does

Allows the duration of step therapy programs for Medicaid-covered prescription drugs to follow evidence-based guidelines from the drug manufacturer and the federal Food and Drug Administration.
Limits step therapy to no longer than thirty days if official guidelines do not exist, after which a doctor may decide the treatment is clinically ineffective.
Requires that once a prescribing practitioner decides a treatment is clinically ineffective, the new prescribed drug must be dispensed and covered under Medicaid.
Mandates written notice at the pharmacy or by mail within 24 business hours when an electronic payment request for a prescription is denied.
Requires written notice by mail at least ten days before planned suspensions of payments for prescribed drugs occur.
Requires written notice about new step therapy rules to be sent with information on how to follow them and the importance of talking to a doctor.

Who It Names or Affects

HUSKY Health plan enrollees who need prescription drugs covered by Medicaid
Pharmacies that submit payment requests for prescriptions
Prescribing practitioners who decide if treatments are effective
The Department of Social Services and its contracted pharmacy benefit administrators

Terms To Know

Step therapy: A rule requiring patients to try a specific drug or treatment before getting coverage for another one.
Prior authorization: A requirement that doctors get approval from the insurance program before prescribing certain drugs, mentioned as part of new requirements needing notice.
HUSKY Health plan enrollee: A person who is signed up for Connecticut's Medicaid or children's health coverage programs.

Limits and Unknowns

The law takes effect immediately upon passage, but the specific date of that event is not listed in this text.
The bill lists federal regulations regarding appeal rights (42 CFR sections) but does not explain the specific steps of those appeals.

Bill History

2026-04-27 LCO
Reported Out of Legislative Commissioners' Office
2026-04-27 Connecticut General Assembly
No New File by Committee on Appropriations
2026-04-27 Connecticut General Assembly
Favorable Report, Tabled for the Calendar, Senate
2026-04-24 APP
Joint Favorable
2026-04-24 LCO
Filed with Legislative Commissioners' Office
2026-04-21 Connecticut General Assembly
Referred by Senate to Committee on Appropriations
2026-04-21 Connecticut General Assembly
Immediate Transmittal
2026-04-07 LCO
Reported Out of Legislative Commissioners' Office
2026-04-07 Connecticut General Assembly
Favorable Report, Tabled for the Calendar, Senate
2026-04-07 Connecticut General Assembly
Senate Calendar Number 274
2026-04-07 LCO
File Number 462
2026-03-30 LCO
Referred to Office of Legislative Research and Office of Fiscal Analysis 04/07/26 12:00 PM
2026-03-20 LCO
Filed with Legislative Commissioners' Office
2026-03-19 HS
Joint Favorable Substitute
2026-02-27 Connecticut General Assembly
Public Hearing 03/03
2026-02-26 Connecticut General Assembly
Referred to Joint Committee on Human Services

Official Summary Text

To align step therapy requirements with manufacturer guidelines for prescription drugs covered under the Medicaid program.

Current Bill Text

Read the full stored bill text

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General Assembly Substitute Bill No. 331
February Session, 2026

AN ACT CONCERNING STEP THERAPY REQUIREMENTS FOR
PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID
PROGRAM AND REQUIRED NOTICE TO ENROLLEES OF
PRESCRIPTION DRUG PAYMENT SUSPENSIONS, DENIALS OR
IMPOSITION OF NEW REQUIREMENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. Subsection (b) of section 17b -274f of the general statutes is 1
repealed and the following is substituted in lieu thereof ( Effective from 2
passage): 3
(b) The duration of any step therapy program requirement [shall] for 4
Medicaid coverage of a prescription drug may follow evidence -based 5
guidelines issued by the manufacturer of the prescription drug and the 6
federal Food and Drug Administration. If no such guidelines exist, step 7
therapy may not be longer than a period of thirty days, after which time 8
the prescribing practitioner may deem such treatment as clinically 9
ineffective for the patient. When the prescribing practitioner deems the 10
treatment to be clinically ineffective, the drug prescribed and 11
recommended by the practitioner shall be dispensed and covered under 12
the Medicaid program. 13
Sec. 2. (NEW) ( Effective from passage ) (a) The Department of Social 14
Services, or any entity under contract with the department to administer 15
pharmacy benefits, shall provide the following notice to a HUSKY 16
Substitute Bill No. 331

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Health plan enrollee affected by a decision by the department to deny 17
or suspend payment for a prescription drug or institute new step 18
therapy or prior authorization requirements: 19
(1) For prescription payment requests submitted electronically by a 20
pharmacy and denied for any reason, an individualized written notice 21
(A) at the pharmacy at the time of the denial, or ( B) through United 22
States mail not later than twenty -four business hours after the time of 23
the denial; 24
(2) For a planned electronic suspension or termination of payment for 25
a prescribed prescription drug, written notice by United States mail not 26
later than ten days before such suspension or termination; and 27
(3) In the event of new prior authorization or step therapy 28
requirements for a prescription drug prescribed to a HUSKY Health 29
plan enrollee, written notice by United States mail at the same time that 30
the department electronically informs prescribers of any such 31
requirements or sixty days before the new requirements are 32
implemented, whichever is earlier. Such notice shall include 33
information in plain language about (A) the new requirements, (B) how 34
to comply with such requirements, and (C) the importance of talking to 35
the prescriber of such prescription drug about alternative prescription 36
drugs that may be available. 37
(b) Notices sent pursuant to this section shall contain information on 38
any due process or appeal rights a HUSKY Health plan enrollee has 39
under federal and state laws and regulations, including, but not limited 40
to, as applicable, the provisions of 42 CFR 431.206, 42 CFR 431. 210 and 41
42 CFR 431.211.42
This act shall take effect as follows and shall amend the following
sections:

Section 1 from passage 17b-274f(b)
Sec. 2 from passage New section

Substitute Bill No. 331

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HS Joint Favorable Subst.
APP Joint Favorable