During the final days of the 2018 legislative session, State Representative Craig Fishbein (R-90) voted in favor of legislation that increases health coverage for women by ensuring insurance carriers properly code mammogram and tomosynthesis screenings, and to provide more oversight into prescription drug formulation, pricing and usage in the state.
The first bill, H.B. 5208 – An Act Concerning Mammograms, Breast Ultrasounds and Magnetic Resonance Imaging of Breasts – makes changes to state law passed in 2016 to expand insurance coverage for mammograms and tomosynthesis by aligning coverage with one of 10 specific medical billing codes.
In 2016, the legislature overwhelmingly supported expanding existing mammogram coverage by including tomosynthesis screenings under covered medical practices. Tomosynthesis, sometimes called three-dimensional (3-D) mammography, uses computer and low-dose x-ray technology to create three-dimensional images of the breasts. Unfortunately, because of a medical coding issue many procedures weren’t being properly covered by insurance companies. This bill will correct those discrepancies and provide proper coverage and reimbursement for qualified procedures.
“Updating our laws to reflect advancements in medical technology, and to make certain that those important, lifesaving advances will be properly covered by insurers, will allow women to get the screenings they need without adding the undue stress created when insurers don’t properly reimburse patients for procedures in accordance with state law,” Rep. Fishbein said. “Early diagnosis of cancer, especially breast cancer, has been a lifesaver for millions of women worldwide and I’m proud to support this change.”
The second, H.B. 5384 – An Act Concerning Prescription Drug Costs – requires pharmacy benefit managers (PBMs) to report information about drug formulary rebates to the insurance commissioner; health carriers to send information on covered outpatient prescription drugs, including the most frequently prescribed drugs and most expensive drugs, to the insurance commissioner; health carriers to certify that they account for all rebates when calculating plan premiums; and for the Office of Health and Safety (OHS) to annually identify up to 10 outpatient prescription drugs provided at substantial state cost or critical to public health and drug manufacturers to report information to OHS on those drugs.
“Healthcare costs are a burden to many Connecticut residents and this legislation will allow the insurance commissioner to more easily monitor the cost structures of commonly used medications being prescribed and sold in the state,” Rep. Fishbein said. “Further, by requiring the reporting of formulation costs, including rebates and prescription rates, the commissioner will be able to work with insurers and patient advocates to identify cost-savings.”
Both bills passed the House of Representatives unanimously and now await action in the Senate. The legislative session ends at midnight on Wednesday, May 9.