Connecticut General Statutes Title 19A. Public Health and Well-Being § 19a-754f. Definitions

(1) “Drug manufacturer” means the manufacturer of a drug that is: (A) Included in the information and data submitted by a health carrier pursuant to section 38a-479qqq, (B) studied or listed pursuant to subsection (c) or (d) of section 19a-754b, or (C) in a therapeutic class of drugs that the Commissioner of Health Strategy determines, through public or private reports, has had a substantial impact on prescription drug expenditures, net of rebates, as a percentage of total health care expenditures;

(2) “Commissioner” means the Commissioner of Health Strategy;

(3) “Health care cost growth benchmark” means the annual benchmark established pursuant to section 19a-754g;

(4) “Health care quality benchmark” means an annual benchmark established pursuant to section 19a-754g;

(5) “Health care provider” has the same meaning as provided in subdivision (1) of subsection (a) of section 19a-17b;

(6) “Net cost of private health insurance” means the difference between premiums earned and benefits incurred, and includes insurers' costs of paying bills, advertising, sales commissions, and other administrative costs, net additions or subtractions from reserves, rate credits and dividends, premium taxes and profits or losses;

(7) “Office” means the Office of Health Strategy established under section 19a-754a;

(8) “Other entity” means a drug manufacturer, pharmacy benefits manager or other health care provider that is not considered a provider entity;

(9) “Payer” means a payer, including Medicaid, Medicare and governmental and nongovernment health plans, and includes any organization acting as payer that is a subsidiary, affiliate or business owned or controlled by a payer that, during a given calendar year, pays health care providers for health care services or pharmacies or provider entities for prescription drugs designated by the Commissioner of Health Strategy;

(10) “Performance year” means the most recent calendar year for which data were submitted for the applicable health care cost growth benchmark, primary care spending target or health care quality benchmark;

(11) “Pharmacy benefits manager” has the same meaning as provided in subdivision (10) of section 38a-479ooo;

(12) “Primary care spending target” means the annual target established pursuant to section 19a-754g;

(13) “Provider entity” means an organized group of clinicians that come together for the purposes of contracting, or are an established billing unit that, at a minimum, includes primary care providers, and that collectively, during any given calendar year, has enough attributed lives to participate in total cost of care contracts, even if they are not engaged in a total cost of care contract;

(14) “Potential gross state product” means a forecasted measure of the economy that equals the sum of the (A) expected growth in national labor force productivity, (B) expected growth in the state's labor force, and (C) expected national inflation, minus the expected state population growth;

(15) “Total health care expenditures” means the sum of all health care expenditures in this state from public and private sources for a given calendar year, including: (A) All claims-based spending paid to providers, net of pharmacy rebates, (B) all patient cost-sharing amounts, and (C) the net cost of private health insurance; and

(16) “Total medical expense” means the total cost of care for the patient population of a payer or provider entity for a given calendar year, where cost is calculated for such year as the sum of (A) all claims-based spending paid to providers by public and private payers, and net of pharmacy rebates, (B) all nonclaims payments for such year, including, but not limited to, incentive payments and care coordination payments, and (C) all patient cost-sharing amounts expressed on a per capita basis for the patient population of a payer or provider entity in this state.