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SB 813

AN ACT LIMITING THE USE OF STEP THERAPY FOR PATIENTS WITH DISABLING OR LIFE-THREATENING CHRONIC DISEASES.

2025 Regular Session Introduced by Saud Anwar and 1 co-sponsor

Connecticut bill exempts patients with serious chronic diseases from insurance step-therapy requirements, allowing faster access to preferred medications without mandatory cheaper treatment failures first.

REF. TO JOINT COMM. ON Insurance and Real Estate
#diseases #medicalcare
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Bill Summary · SB 813

Legislative bill overview

SB 813 restricts insurance companies' use of step therapy (also called "fail-first" protocols) for patients with disabling or life-threatening chronic diseases. Step therapy requires patients to try and fail on cheaper treatments before insurers will cover more expensive medications. This bill would create an exemption or streamlined process for certain high-need patients to access preferred treatments more quickly.

Why is this important

Step therapy can delay critical treatment for patients with serious conditions, potentially worsening health outcomes or prolonging suffering while waiting for insurance approval. For chronic diseases like cancer, rheumatoid arthritis, or severe psychiatric conditions, treatment delays can be particularly harmful. The bill addresses a real tension between cost control and patient access to effective medications.

Potential points of contention

  • Cost implications: Insurers argue step therapy reduces unnecessary spending; opponents counter that denying proven treatments is penny-wise but pound-foolish and shifts costs to patients through delayed care and complications
  • Definition ambiguity: "Disabling or life-threatening chronic diseases" is subjective—disagreement likely over which conditions qualify and who determines eligibility
  • Implementation burden: Creating exemption processes requires medical review infrastructure; unclear whether costs fall on insurers, providers, or the state

Compiled from official sources — confirm details with the bill’s official record.

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