Conn. Gen. Stat. § 38a-477qq: (Note: This section is effective July 1, 2026.) Cost-sharing credits for out-of-pocket expenses.

(a) As used in this section:

(1) “Enrollee” has the same meaning as provided in section 38a-478;

(2) “Health benefit plan” has the same meaning as provided in section 38a-472f; and

(3) “Health carrier” has the same meaning as provided in section 38a-591a.

(b) Each insurer, health care center, hospital service corporation, medical service corporation, fraternal benefit society or other entity that delivers, issues for delivery, renews, amends or continues an individual or a group health insurance policy or health benefit plan in this state on or after January 1, 2026, providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 in this state, shall, when calculating an insured's or enrollee's in-network liability for such insured's or enrollee's annual coinsurance, copayment, deductible or other in-network out-of-pocket expense, give credit for any out-of-pocket expense such insured or enrollee pays directly to any pharmacy licensed pursuant to section 20-594 or health care provider licensed in this state, for any prescription drug, provided (1) no claim for such prescription drug was submitted to such insurer, center, corporation, society or other entity, and (2) such out-of-pocket expense paid by such insured or enrollee to such pharmacy or health care provider is less than the average discounted rate for such prescription drug paid to an in-network health care provider pursuant to the terms of such health insurance policy or health benefit plan.

(c) If any insured or enrollee purchases a prescription drug from any out-of-network health care provider for a lower amount than the average amount paid by such insured's or enrollee's health carrier to any in-network health care provider for the same prescription drug, such health carrier, when calculating such insured's or enrollee's liability for such insured's or enrollee's in-network annual coinsurance, copayment, deductible or other out-of-pocket expense, shall give credit for such purchase, provided such insured or enrollee provides such health carrier with proof of payment for such prescription drug in accordance with the provisions of subsection (d) of this section. Nothing in this subsection shall be construed to restrict any health insurance policy or health benefit plan from requiring a prior authorization or precertification otherwise provided for in the insured's or enrollee's health insurance policy or health benefit plan.

(d) Each health carrier shall (1) develop a proof of payment form and publish such form on such health carrier's Internet web site for insureds and enrollees to submit proof of payment for any out-of-network prescription drug purchase pursuant to subsection (c) of this section, and (2) annually provide to such insureds and enrollees written notice of, and instructions for downloading or electronic submission of, such proof of payment form.

(e) Upon receipt of any such proof of payment form submitted by any insured or enrollee pursuant to subsection (d) of this section, each health carrier shall give credit for any out-of-pocket payments that such insured or enrollee paid to any out-of-network pharmacy or health care provider in accordance with the provisions of subsection (c) of this section, provided (1) the prescription drug purchased by such insured or enrollee is included under such insured's or enrollee's health insurance policy or health benefit plan, and (2) such insured or enrollee purchased such prescription drug for a lower price than the average amount paid by such insured or enrollee's health carrier to an in-network health care provider for the same prescription drug.

(f) The total amount credited toward any insured's or enrollee's annual coinsurance, copayment, deductible or other out-of-pocket expense pursuant to subsection (e) of this section shall not (1) exceed the total amount that such insured or enrollee is required to pay out-of-pocket under the terms of the health insurance policy or health benefit plan during a policy period, and (2) carry over to a new policy period.