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--- version:File No. 403
+++ version:(document, no version)
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-House of Representatives
-sHB5040 / File No. 403  1
+OFFICE OF FISCAL ANALYSIS
+Legislative Office Building, Room 5200
+Hartford, CT 06106  (860) 240-0200
+http://www.cga.ct.gov/ofa
+sHB-5040
+AN ACT IMPLEMENTING THE GOVERNOR'S BUDGET
+RECOMMENDATIONS FOR HEALTH AND HUMAN SERVICES.
 
-General Assembly File No. 403
-February Session, 2026 Substitute House Bill No. 5040
-
-House of Representatives, April 7, 2026
-
-The Committee on Human Services  reported through REP.
-GILCHREST of the 18th Dist., Chairperson of the Committee on
-the part of the House, that the substitute bill ought to pass.
-
- AN ACT IMPLEMENTING THE GOVERNOR'S BUDGET
-RECOMMENDATIONS FOR HEALTH AND HUMAN SERVICES.
-Be it enacted by the Senate and House of Representatives in General
-Assembly convened:
-
-Section 1. Subsection (b) of section 17b-191 of the 2026 supplement to 1
-the general statutes is repealed and the following is substituted in lieu 2
-thereof (Effective July 1, 2026): 3
-(b) The state-administered general assistance program shall provide 4
-cash assistance of [(1)] two hundred sixty-nine dollars per month [for an 5
-unemployable person upon determination of such person's 6
-unemployability; (2) two hundred dollars per month for a transitional 7
-person who is required to pay for shelter; and (3) fifty dollars per month 8
-for a transitional person who is not required to pay for shelter ] to 9
-persons eligible for the program . The standard of assistance paid for 10
-individuals residing in rated boarding facilities shall remain at the level 11
-in effect on August 31, 2003. No person shall be eligible for cash 12
-assistance under the program if eligible for cash assistance under any 13
-other state or federal cash assistance program. The standards of 14
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-
-assistance set forth in this subsection shall be subject to annual increases, 15
-as described in subsection (b) of section 17b-104. 16
-Sec. 2. Subsection (f) of section 17b -274d of the general statutes is 17
-repealed and the following is substituted in lieu thereof (Effective July 1, 18
-2026): 19
-(f) Nonpreferred drugs in the classes of drugs included on the 20
-preferred drug lists shall be subject to prior authorization. Prior 21
-authorization is not required for any mental -health-related drug that 22
-has been filled or refilled, in any dosage, at least one time in the one -23
-year period prior to the date the individual presents a prescription for 24
-the drug at a pharmacy. If prior authorization is granted for a drug not 25
-included on a preferred drug list, the authorization shall be valid for one 26
-year from the date the prescription is first filled. [Antiretroviral classes 27
-of drugs shall not be included on the preferred drug lists.] 28
-Sec. 3. (NEW) ( Effective July 1, 2026 ) (a) The Commissioner of Social 29
-Services may periodically review available data on the clinical 30
-effectiveness of outpatient prescription drugs covered under the 31
-Medicaid program that are projected to exceed (1) a net cost per 32
-consumer, after factoring in rebates, of twenty-five thousand dollars per 33
-year, or (2) an annual aggregate cost, after factoring in rebates to the 34
-medical assistance program, of ten million dollars. The commissioner 35
-may, within available appropriations, contract with a third party to 36
-conduct a comparative effectiveness review of any such outpatient 37
-prescription drug. For purposes of this section, "rebate" means an 38
-amount sent to the state by a prescription drug manufacturer to offset 39
-the cost of outpatient prescription drugs covered by the Medicaid 40
-program. 41
-(b) Any such comparative effectiveness review shall include, but 42
-need not be limited to: (1) Clinical efficacy and outcomes; (2) 43
-information relating to the pricing of the outpatient prescription drug, 44
-including, but not limited to, information relating to prices paid by other 45
-states or developed nations; (3) such drug's net price to the Medicaid 46
-program as compared to its therapeutic benefits, including, but not 47
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-limited to, the seriousness and prevalence of the disease or condition 48
-that is treated by the drug; (4) the extent of utilization of such drug; (5) 49
-the likelihood that the use of such drug will reduce the need for other 50
-medical care; (6) the number of manufacturers that produce such drug; 51
-and (7) whether there are pharmaceutical equivalents of such drug. 52
-(c) The Commissioner of Social Service may make public and share 53
-the results of any comparative effectiveness review with any entity, 54
-including any multistate prescription drug purchasing collaborative in 55
-which the state is a participating member, in order to negotiate 56
-additional supplemental rebate agreements beyond any rebates 57
-required under federal law. 58
-This act shall take effect as follows and shall amend the following
-sections:
-
-Section 1 July 1, 2026 17b-191(b)
-Sec. 2 July 1, 2026 17b-274d(f)
-Sec. 3 July 1, 2026 New section
-
-Statement of Legislative Commissioners:
-In Section 3(a)(2) and 3(b), references to "prescription drugs" were
-changed to "outpatient prescription drugs" or "such drug" for
-consistency, and the provisions of Section 3(c) were rewritten for clarity.
-
-HS Joint Favorable Subst.
-
-sHB5040 File No. 403
-
-sHB5040 / File No. 403  4
-
-The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
-the General Assembly, solely for purposes of information, summarization and explanation and do not
-represent the intent of the General Assembly or either chamber thereof for any purpose.  In general,
-fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
-knowledge.  Whenever applicable, agency data is consulted as part of the analysis, however final
-products do not necessarily reflect an assessment from any specific department.
+Primary Analyst: ES 4/6/26
+Contributing Analyst(s): LD
+Reviewer: RW
 
 OFA Fiscal Note
 
@@ -128,95 +32,3 @@
 The annualized ongoing fiscal impact identified above would
 continue into the future subject to service utilization and supplemental
 rebates.
-
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-sHB5040 / File No. 403  5
-
-OLR Bill Analysis
-sHB 5040
-
-AN ACT IMPLEMENTING THE GOVERNOR'S BUDGET
-RECOMMENDATIONS FOR HEALTH AND HUMAN SERVICES.
-
-SUMMARY
-This bill makes various unrelated changes to human services-related
-statutes. Specifically, the bill:
-1. sets a standardized $269 monthly cash benefit for State
-Administered General Assistance (SAGA) beneficiaries, thereby
-eliminating current law’s payment reduction for certain
-transitional people (§ 1);
-2. adds antiretroviral drugs to the Medicaid preferred drug lists,
-allowing the state to negotiate supplemental rebates with drug
-manufacturers for these drugs (§ 2); and
-3. authorizes the Department of Social Services (DSS) commissioner
-to periodically review available data on the clinical effectiveness
-of certain Medicaid-covered outpatient prescription drugs (§ 3).
-EFFECTIVE DATE: July 1, 2026
-§ 1 — SAGA BENEFITS
-The bill sets a standardized $269  monthly cash benefit for SAGA
-beneficiaries (subject to future cost of living adjustments), and in doing
-so, eliminates current law’s temporary payment reduction for certain
-transitional people.
- By law, SAGA generally provides cash assistance to single or
-married childless people who have very low incomes, do not qualify for
-other cash assistance programs, and are considered “transitional” or
-“unemployable.” Under current law, monthly benefits are $2 62 for
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-sHB5040 / File No. 403  6
-
-unemployable individuals and transitional recipients who must pay for
-their shelter and $ 66 for transitional recipients who do not pay for
-shelter (these benefit amounts account for annual cost of living
-adjustments). For the latter , in practice  DSS sends the transitional
-person’s medical information to an independent reviewer , and if the
-person is deemed medically unemployable, the person’s monthly
-benefit retroactively increases to $262.
-§ 2 — MEDICAID PREFERRED DRUG LIST AND ANTIRETROVIRAL
-DRUGS
-The bill adds antiretroviral drugs to the Medicaid preferred drug
-lists, and in doing so, allows the state to negotiate supplemental rebates
-with drug manufacturers for them. (This group of medications is used
-to prevent and treat HIV.)
-By law, DSS, in consultation with the Medicaid Pharmaceutical and
-Therapeutics Committee, may establish a preferred drug list
-(formulary) that limits the number of drugs that may be dispensed
-under the Medicaid program. Nonpreferred drugs in the drug classes
-included on the preferred drug list are subject to prior authorization.
-Under current law, classes of antiretroviral drugs are exempt from prior
-authorization requirements and cannot be included on preferred drug
-lists.
-§ 3 — PERIODIC REVIEW OF MEDICAID PRESCRIPTION DRUGS
-The bill authorizes the DSS commissioner to periodically review
-available data on the clinical effectiveness of Medicaid -covered
-outpatient prescription drugs that are projected to exceed, after
-factoring in rebates , (1) a per -consumer net cost of $25,000 per year or
-(2) an aggregate annual cost to the program of $10 million.
-Under the bill, the commissioner may, within available
-appropriations, contract with a third  party to conduct a comparative
-effectiveness review of any of these prescription drugs. At a minimum,
-this review must include the following:
-1. clinical efficacy and outcomes;
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-
-2. pricing-related information, such as prices paid by other states or
-developed nations;
-3. the prescription drug’s net price to the program compared to its
-therapeutic benefits, such as the seriousness and prevalence of
-the disease or condition the drug is treating;
-4. the extent of the prescription drug’s use and the likelihood that
-its use will reduce the need for other medical care;
-5. how many manufacturers produce it; and
-6. whether there are pharmaceutical equivalents.
-Under the bill, the results of the review may be made public and
-shared with any entity or multi -state prescription drug purchasing
-collaborative that Connecticut is a member of , to help negotiate
-additional supplemental rebate agreements beyond those required
-under federal law.
-COMMITTEE ACTION
-Human Services Committee
-Joint Favorable Substitute
-Yea 23 Nay 0 (03/19/2026)