Connecticut Lawmakers Seek More Regulation of Stop-Loss, PBM Practices, and AI

CT legislators voted on SB 10, which would prohibit the use of stop-loss as a risk protection tool for employer plans unless the plan covers essential health benefits and state benefit mandates, or the stop-loss policy adheres to newly revised attachment points that vary based on the employer size.

The bill also establishes certain prohibitions on the use of step therapy for prescription drugs and prohibits the use of artificial intelligence (AI) to make adverse determinations based on medical necessity. Lawmakers’ objections to the stop-loss provisions necessitated the removal of that section before the bill could be successfully voted out of committee.

Unfortunately, the same stop-loss provisions remain in SB 11, which was heard and passed out of the Human Services Committee in March. SB 11 also includes anti-PBM language such as a delinking requirement, a fiduciary duty standard, and a ban on the use spread pricing contracts.