In Review: The Connecticut legislature adjourned early Thursday morning where PCMA successfully defeated a ban on step therapy, requiring the carrier to provide the burden of proving that medication is unnecessary and a prescription drug affordability board with the ability to set upper payment limits. The definition of a clinical peer was changed, requiring a carrier to use a physician or other healthcare professional with the same specialty as the treating physician or other healthcare professional to reverse an initial adverse determination for prior authorizations. The legislature delayed the implementation of this change in definition for clinical peer to January 1, 2026.

If you have any questions, please contact Sam Hallemeier at shallemeier@pcmanet.org.