Annual Filing of Formularies (repealed and replaced Bulletin HC-113)

STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin No. HC-113-17 · March 2, 2017 TO: All Health Insurance Companies and Health Care Centers Authorized to Conduct Business in Connecticut RE: Annual Filing of Formularies . Thl~ bUlletin repeals and replaces BUiietin HC-1 f3 in order to set a due date for the annual filing. PursUant to the authority under Sections §38a-59l(e) ofthe 2016 Supplement to and Sections 38a-481 and 38a-513 ofthe Connecticut General Statutes, the Insurance Department will require · carriers to file th~ir prescription drug formularies for all plans, whether or not such plans are subjeCt to the ACA, to ensure consistency and transparency in the marketplace. The purpose of this bulletin is t~ set requirements and minimum standards for prescription drug formularies filed with the Department, and to solicit information relating to the policies and procedures for Pharmacy and Therapeutics Committees in developing these formularies. Formulary Requirements • The formulary shall be easily electronically searchable. • The medications within the formulary shall be grouped in alphabetical order by therapeutic class. . • .:... ·Definition and/or explanation ofeach formulary tier, including Specialty tier; shall be-- --- -----­ clearly stated. · • Definitions for utilization controls, including but not limited to quantity/dosage controls, prior authorization, and step therapy shall be clearly stated. • Tier coverage and utilization controls for each medication (by dosage, ifapplicable), shall be clearly stated. • The formulary shall include ~ormation on how to obtain drugs that are offformulary. • The formulary shall specify ifand how drugs could be obtained through mail order pharmacy. • The formulary shall clearly state ·when it was created, when it was last updated, and when the next anticipated update will be. • The formulary shall provide customer service contact information. Policies and Procedures for Pharmaceutical and Therapeutic Committees The Department is seeking to determine whether P &T Committees generally comply with the federal requirements articulated at 45 C.F.R. 122(a)(3). In furtherance ofthe Department's www.ct.gov/cid P.O. Box 816 • Hartford, CT 06142-0816 An Equal Opportunity Employer regulatory role under C.G.S. 2016 Supplement Section 38a-591(e), the Commissioner requests that each insurer that files a drug formulary under the prior paragraph also provide a copy ofthe policies and procedures that govern its P&T Committee in its management ofthe formulary, with particular emphasis on the Committee's membership requirements, conflict ofinterest prohibitions and drug distribution and anti-discrimination processes. Annual Filing The Connecticut Insurance Department will conduct an annual survey ofthe carriers to gather information to complete the annual evaluation. The formulary survey form will be on the Insurance Department's website (www.ct.gov/cid) under the tab "Forms and Applications." The survey form may also be requested from the Life and Health Division at the address listed below. The survey should be submitted on May 1, 2017 and annually thereafter on May 1. Questions Please contact the Insurance Department Life and Health Division at cid.lh@ct.gov with any questions. L.w~ Katharine L. Wade Insurance Commissioner