An Act Concerning The Recommendations Of The Insurance And Real Estate Committee Working Groups.
Summary
HB 5375 is an insurance and health-care related act that contains two main policy changes. First, it directs the Insurance Commissioner to study and develop a proposed plan for a possible captive insurance company, risk management agency, or similar program to help nonprofit entities that contract with the state pool liability insurance coverage. The study must examine feasibility, structure, data collection, actuarial risk, financial viability, startup capital needs, and projected premium costs, and the commissioner must report findings and recommendations to the legislature by November 1, 2026.
Second, beginning January 1, 2028, the bill requires health carriers, third-party administrators, and pharmacy benefits managers to include pharmacists in reimbursement processes and provider networks for covered clinical services. It bars denial of reimbursement solely because a covered clinical service was provided by a pharmacist acting within the pharmacist’s scope of practice, so long as the same service would be reimbursable if provided by a physician, physician assistant, or advanced practice registered nurse. The bill does not require coverage of services not already covered under the plan and preserves the ability of carriers and administrators to apply reasonable credentialing and contracting standards.
Impact
The bill would not immediately create a new insurance pool or captive entity, but it would require the Insurance Commissioner to conduct a formal feasibility study and financial analysis that could lead to future legislation or implementation funding for nonprofit liability coverage. It also amends the practical administration of health benefit plans in Connecticut by expanding reimbursement access for pharmacist-provided clinical services, affecting insurers, third-party administrators, pharmacy benefits managers, pharmacists, and patients covered by health plans. The pharmacist reimbursement provisions are effective in 2028 and may be implemented through regulations adopted by the Insurance Commissioner.
Sentiment
The recorded votes show strong and unanimous support at each stage, with no recorded opposition in committee or on the House and Senate floor. The bill appears to have been viewed as a technical but constructive measure that advances committee working-group recommendations and addresses both nonprofit insurance needs and pharmacist reimbursement issues without imposing broad new coverage mandates.
Contention
There is little evidence of substantive contention in the available record, likely because the bill is framed as a study and planning measure for nonprofit insurance and as a targeted reimbursement parity provision for pharmacists. Any potential concerns would likely center on the cost and administrative impact on health carriers, third-party administrators, and pharmacy benefits managers, as well as the feasibility and funding requirements of establishing a nonprofit captive insurance or risk-pooling program. The bill addresses those concerns in part by limiting the pharmacist provision to already-covered services and by requiring the commissioner’s study to evaluate financial viability before any nonprofit insurance program is created.