HB 21-1297

  • Colorado House Bill
  • 2021 Regular Session
  • Introduced in House May 24, 2021
  • Passed House May 24, 2021
  • Passed Senate Jun 01, 2021
  • Signed by Governor Jul 06, 2021

Pharmacy Benefit Manager And Insurer Requirements

Abstract

The bill precludes a health insurer, a pharmacy benefit manager (PBM), or an entity acting for a health insurer or PBM to conduct on-site audits of pharmacies within 12 months after a prior on-site audit except in specified circumstances. Additionally, the bill enacts the "Pharmacy Fairness Act" (act), which imposes requirements regarding contracts between PBMs and pharmacies as follows: Requires a health insurer to submit to the commissioner of insurance (commissioner) a list of PBMs the health insurer uses to manage or administer prescription drug benefits under its health benefit plans offered in this state; Prohibits PBMs from: Restricting a covered person's access to prescription drug benefits at an in-network retail pharmacy, except as permitted in limited circumstances; Charging a pharmacy or pharmacist a fee for adjudicating a claim, other than a one-time fee of not more than the lesser of 25% of the pharmacy dispensing fee or 25 cents for receipt and processing of the same pharmacy claim; or Requiring stricter pharmacy accreditation standards or certification requirements than the standards or requirements that are applicable to similarly situated PBM-affiliated pharmacies within the same PBM network. or Refusing to designate a pharmacy located in a county with a population of 20,000 or fewer as a preferred pharmacy under the health benefit plan. A PBM that administers the drug assistance program operated by the department of public health and environment is exempt from the requirements and prohibitions of the act with regard to the PBM's administration of that program only. The bill also : Requires requires a health insurer or PBM to respond in real time to a request from an insured, the insured's health care provider, or a third party acting on behalf of the insured or provider for data regarding the cost, benefits, and coverage under the insured's health benefit plan for a particular drug. and Requires a health insurer or PBM that removes a prescription drug from the prescription drug formulary or moves a prescription drug to a higher cost tier on the formulary during the benefit year to notify a covered person that is prescribed that drug at least 30 days before the action and allow the covered person to continue using the drug without prior authorization and at the same coverage level for the remainder of the benefit year, except in specified circumstances. (Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.) (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Bill Sponsors (4)

Votes


May 24, 2021

Jun 01, 2021

Actions


Jul 06, 2021

Office of the Governor

Governor Signed

Jun 24, 2021

Office of the Governor

Sent to the Governor

House

Signed by the Speaker of the House

Senate

Signed by the President of the Senate

Jun 01, 2021

Senate

Senate Third Reading Passed - No Amendments

May 28, 2021

Senate

Senate Second Reading Special Order - Passed - No Amendments

May 27, 2021

Senate

Senate Committee on State, Veterans, & Military Affairs Refer Unamended to Senate Committee of the Whole

  • Committee-Passage
  • Referral-Committee
Senate Committee of the Whole State, Veterans, & Military Affairs

May 24, 2021

Senate

Introduced In Senate - Assigned to State, Veterans, & Military Affairs

  • Introduction
State, Veterans, & Military Affairs

House

House Third Reading Passed - No Amendments

May 22, 2021

House

House Second Reading Special Order - Passed with Amendments - Committee

May 21, 2021

House

House Second Reading Special Order - Laid Over Daily - No Amendments

May 19, 2021

House

House Committee on Health & Insurance Refer Amended to House Committee of the Whole

  • Committee-Passage
  • Referral-Committee
House Committee of the Whole

Apr 28, 2021

House

Introduced In House - Assigned to Health & Insurance

  • Introduction
Health & Insurance

Bill Text

Bill Text Versions Format
Signed Act (07/06/2021) PDF
Final Act (06/24/2021) PDF
Rerevised (06/01/2021) PDF
Revised (05/28/2021) PDF
Reengrossed (05/24/2021) PDF
Engrossed (05/22/2021) PDF
Introduced (04/28/2021) PDF
PA1 (05/21/2021) PDF
Committee Amendment PDF

Related Documents

Document Format
Fiscal Note FN1 (05/04/2021) PDF

Sources

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