Senate Passes Rep. Cook's Bill Prohibiting Non-Medical Switching

June 5, 2021

State Representative Michelle L. Cook (D - Torrington) applauds the Connecticut Senate's passage of legislation to lower prescription drug costs for consumers by prohibiting insurers from practicing non-medical switching, or changing the list of covered drugs during a plan year.

On Friday, June 4, the Senate voted to pass the bill. It now goes to Governor Ned Lamont for consideration.

"This bill offers a path to lower prescription drug prices for Connecticut residents and will help ensure continuity of care. I have been working on this legislation for several years and am so happy to see it pass. This bill will help those with medical needs and will ensure insurers cannot reject a doctor’s prescription," said Rep. Cook. "We know adding prescription medications to a higher cost-sharing tier or stopping coverage altogether can have negative health outcomes for patients. We've heard stories from residents across the state about having to ration their medications or forego the medication because they could no longer afford it. Consumers should not have to foot the bill for an insurer's pursuit to profit."

The legislation limits a health insurer's ability to remove safe and effective prescription medication form their list of covered drugs or shift a drug to a higher cost tier during a plan year. The bill will allow a health carrier to move a drug to a higher cost-sharing tier as long as the out-of-pocket expense for consumers does not exceed $40 per month per prescription. The bill would permit carriers to move a prescription drug to a higher tier if an equivalent drug is added to a lower cost sharing tier. Insurers may remove a drug from its formulary if the drug has been approved for over-the-counter use, or if the U.S. Food and Drug Administration deems it harmful. 

The bill strengthens protections for patients and will help mitigate the negative health impacts of non-medical switching. Patients with chronic oftentimes work with their healthcare provider to find an effective treatment to help manage their condition, but when the patient is driven to a less expensive treatment option, there can be adverse outcomes.

A 2019 study conducted by the Alliance for Patient Access found that 40 percent of patients found the new, cheaper medication was less effective than the original, and 60 percent experienced health complications from the new treatment. According to the study, approximately 10 percent of patients were hospitalized.