Battling with your insurance? New state law makes it easier to get drugs covered

On Thursday, Gov. Ned Lamont signed a new law permanently banning "step therapy" for rheumatoid arthritis, multiple sclerosis and mental health drugs. It means insurance carriers can no longer require patients to try cheaper alternatives first.

John Craven

Jul 10, 2025, 8:51 PM

Updated 6 hr ago

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Anyone with health insurance knows this frustration: Your doctor prescribes a drug, but your carrier won’t pay for it until you try cheaper alternatives first.
It’s called “step therapy.”
Now, a new law signed by Gov. Ned Lamont on Thursday bans the practice for thousands of patients across Connecticut.
“THAT IS TERRIBLE”
At the Norwalk Senior Center, a roomful of arthritis patients are stretching their joints.
Most are on medication – and all of them have battled with insurance.
“Oh, that is terrible," said Peggy McDonald, who has suffered from arthritis for years. “Like an injection, when they make you take an oral one instead of an injection."
NEW LAW = FEWER OBSTACLES
But soon, patients like McDonald will face fewer obstacles.
The new law bans step therapy for rheumatoid arthritis and multiple sclerosis drugs starting in Jan. 2026.
“We stopped the Tremfya and went on this Xeljanz, and we’re hoping that this is going to work," McDonald said.
The law also permanently bans step therapy for depression, schizophrenia and bipolar disorder medications. Those restrictions were first prohibited six years ago, but were set to expire in 2027.
Insurers will also face new penalties if they don’t cover mental health treatment on par with physical ailments.
“For too long, insurance companies have been violating mental health parity laws with little consequence – denying care, under-paying providers,” said Mental Health Connecticut policy director Christian Damiana. “With this law, Connecticut now has one of the strongest parity enforcement frameworks in the country, real civil penalties, new transparency requirements and clear authority for the state to act when insurers don’t comply."
The legislation could also save you money. Starting in 2027, the Connecticut Insurance Department will have the power to reduce carriers’ rate requests by 2% if their previous two increases exceeded the state’s growth targets.
“It’s a way that we can try to help bend the cost curve, drive down the cost, make the system more efficient,” said Connecticut insurance commissioner Andrew Mais.
INSURANCE INDUSTRY CONCERNS
The original bill went much further, designating treatments “medically necessary” unless an insurer could prove otherwise.
“This is a mandate on fully-insured plans that could increase annual costs by tens of millions of dollars," the Connecticut Business and Industry Association told state lawmakers.
It also placed new mandates on self-funded plans.
Both proposals were dropped after insurance carriers, small businesses and local governments warned that it could spike premiums.
“The onerous provisions outlined in SB 10 would effectively prevent employers of all sizes from self funding benefit plans for their employees, and would make stop loss insurance unaffordable,” Flagship Networks said in written testimony.
As for step therapy, McDonald thinks that insurers will actually save money by giving patients the drugs they need – and not wasting time on medications unlikely to work.
“Why should somebody that has arthritis take medication that’s not as good as the other one?” she asked.