Connecticut's legislative leaders have introduced a pair of bills designed to address escalating healthcare and insurance expenses. Both parties acknowledge past efforts have fallen short of voter expectations, but they emphasize that affordability remains a top priority this session. The proposals focus on enhancing transparency and accountability in pharmaceutical benefit management, improving access to affordable medications, and streamlining prior authorization processes for medical treatments. Additionally, lawmakers aim to gather more comprehensive data from the healthcare industry to better regulate price benchmarks.

Enhancing Accountability in Pharmaceutical Benefit Management

Lawmakers are proposing new regulations to ensure that pharmaceutical benefit managers (PBMs) act in the best interest of patients. This initiative seeks to establish fiduciary responsibilities for PBMs, allowing patients or the attorney general to hold them accountable if they fail to pass on negotiated savings. Critics argue that current practices often result in significant profits for PBMs without benefiting consumers. A recent federal report highlighted that over $8.7 billion in savings did not reach patients between 2017 and 2022. By introducing these changes, legislators hope to create a more transparent and patient-centric system.

The proposed legislation aims to address the opaque practices of PBMs by mandating greater transparency and accountability. Currently, PBMs operate as intermediaries between drug manufacturers and insurers, negotiating lower prices on prescription drugs. However, many critics contend that these savings do not trickle down to consumers. By establishing fiduciary duties, the new laws would require PBMs to prioritize patient welfare. This shift could lead to more equitable distribution of cost savings and potentially reduce overall healthcare expenditures. Furthermore, the bill would empower patients and regulators to challenge any practices that undermine consumer interests.

Streamlining Insurance Authorization and Data Transparency

To improve access to necessary medical treatments, lawmakers propose making it harder for health insurers to deny prior authorization requests. Insurers would need to provide clear justification for rejecting a doctor’s recommendation for care. This measure aims to streamline the authorization process and ensure that patients receive timely and appropriate treatment. Additionally, there is a push to enhance data sharing within the healthcare sector, particularly with the Office of Health Strategies, to set realistic price benchmarks.

Republicans support exploring various solutions, including enabling small businesses to pool resources for purchasing insurance. They also advocate for increased data transparency to facilitate better price benchmarking. Connecticut is among a few states attempting to set goals for healthcare cost growth, but obtaining the necessary data has been challenging. By mandating more comprehensive reporting from the healthcare industry, policymakers hope to gain deeper insights into pricing trends and develop more effective regulatory strategies. While some stakeholders express concerns about potential cost increases, business groups like the Connecticut Business and Industry Association welcome efforts to reduce healthcare expenses for employees.