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.

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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repealed and the following is substituted in lieu thereof ( Effective from 2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