New Connecticut Law Expands Patient Control Over Prescription Coverage
As of January 1, 2026, people in Connecticut have more control over how they receive and manage their prescription medications, thanks to a new law that changes two long-standing health insurance practices. The updates, part of Public Act No. 25-94, apply to both individual and group health insurance plans and are designed to remove barriers that often delay or complicate care—especially for patients dealing with serious or chronic illnesses.
One of the most important changes is how the law now limits the use of “step therapy.” Step therapy is an insurance practice where patients are required to try and “fail” cheaper medications before the insurer agrees to cover a more expensive one prescribed by their doctor. This “fail first” approach can delay the use of more effective drugs, sometimes requiring documentation that a patient’s condition continues to worsen before allowing access to newer, more effective treatments.
Under the new rules, step therapy cannot be used for more than 30 days. After that, a patient’s doctor has the right to declare the treatment ineffective and request immediate approval for the originally prescribed drug. If the drug is covered by the plan, the insurance company must approve it without further delay (Public Act No. 25-94).
Even more significant is the fact that step therapy can no longer be used at all for patients being treated for stage IV metastatic cancer, multiple sclerosis, rheumatoid arthritis, schizophrenia, major depressive disorder, or bipolar disorder. These are complex, often life-threatening or deeply disruptive illnesses. With this law, doctors—not insurers—have the final say in the treatment path for those conditions. As News 12 Connecticut reports, patients no longer have to “fail first” before getting access to the medication their doctor believes is best for them.
The law also ends a common frustration for patients: being forced to use a mail-order pharmacy. Previously, insurance companies could deny benefits unless prescriptions were filled through the insurer’s preferred mail-order service. That’s no longer allowed. Now, patients can choose to use their local pharmacy, whether for convenience, personal preference, or a need for faster service. Insurers cannot require mail-order pharmacies as a condition for coverage.
Together, these changes reflect a growing effort by lawmakers to prioritize patient care over cost-control measures that many say go too far. For families navigating serious mental or physical health conditions, delays in treatment can carry significant risks. By ensuring timely access to the medications doctors believe are best, the new law helps reduce that burden.
At Guendelberger Law Offices, we pay close attention to changes like this because the law is most powerful when it serves real people—not systems or shortcuts. Just as this legislation recognizes that patients don’t fit into rigid, one-size-fits-all insurance rules, we believe clients deserve legal guidance shaped around their specific circumstances, not a predefined process or billboard-style formula. The law should work for individuals, and that principle guides how we advocate every day.