With healthcare dominating the national political arena, Gov. Ned Lamont has made the issue one of his priorities for the 2020 legislative session through an ambitious bill.

The proposals outlined in HB 5018 are not new concepts to the legislature, as many of them were included in the public option amendment from last session. 

Annual healthcare spending per person in Connecticut
Sources: State Office of Legislative Research, Kaiser Family Foundation.

The bill charges the Office of Health Strategy with establishing both cost and quality benchmarks, modeling a program recently implemented in Massachusetts.

By December 2020, cost benchmarks will be set using a variety of criteria to limit the total growth of healthcare expenditures for the succeeding year. 

These benchmarks will apply to providers, payers, device and drug manufacturers, as well as pharmacy benefit managers. 

The bill sets a goal for 10% of total healthcare expenditures to go towards primary care services by 2025.

In an effort to incentivize preventative care, the bill sets a goal for 10% of total healthcare expenditures to go towards primary care services by 2025. 

While healthcare costs have been top of mind, the administration stresses the importance of maintaining high-quality care as well. 

OHS is also directed to set quality benchmarks by 2022 to be based off of recognized quality measures and patient-centered outcomes. 

Drug Importation 

Another concept that the governor revived from last session is a proposal for drug importation. 

The bill tasks the Commissioner of Consumer Protection with the application and implementation of the Canadian Legend Drug Importation program. 

The bill allows participating wholesalers to distribute prescription drugs in Connecticut.

The bill allows participating wholesalers to distribute legend drugs—those dispensed by prescription or used by a prescribing practitioner—in Connecticut.

While there are potentially significant cost advantages that could result from this program, drug authenticity has been cited as a public health concern.

Stop-Loss Codification 

Although the last portion of the governor's healthcare proposal was not a result of the public option bill, it is not a topic unfamiliar to insurance legislation. 

Currently, Connecticut law requires that stop-loss policies be filed with and approved by the insurance commissioner, giving the department ample regulatory discretion.

Insurance department guidance calls for attachment points to be set so that payment by the stop-loss insurer is not an actuarial certainty. 

Bulletin HC-126 further requires stop-loss policies to meet the NAIC model act minimum requirements, imposes requirements to distinguish stop-loss policies from health insurance, and establishes restrictions on lasering. 

All of which would be codified into statute if the legislature adopts the governor's bill. 

For more information, contact CBIA's Michelle Rakebrand (860.244.1921) | @MRakebrand

Filed Under: Healthcare

Leave a Reply

Your email address will not be published.