First Regular Session Seventy-fourth General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO. 23-0428.01 Kristen Forrestal x4217 HOUSE BILL 23-1002 House Committees Senate Committees Health & Insurance Health & Human Services Appropriations Appropriations A BILL FOR AN ACT C ONCERNING THE AFFORDABILITY OF EPINEPHRINE AUTO-INJECTORS,101 AND, IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.102 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov .) Effective January 1, 2024, the bill creates an epinephrine auto-injector affordability program (program) to provide low-cost epinephrine auto-injectors to individuals who: ! Are residents of this state; ! Are not enrolled in the state medicaid program or the federal medicare program; SENATE 3rd Reading Unamended April 21, 2023 SENATE Amended 2nd Reading April 20, 2023 HOUSE 3rd Reading Unamended March 8, 2023 HOUSE Amended 2nd Reading March 7, 2023 HOUSE SPONSORSHIP Mabrey and Jodeh, Amabile, Bacon, Bird, Boesenecker, Brown, Daugherty, Dickson, Duran, Froelich, Garcia, Kipp, Lieder, Lindsay, Lukens, Martinez, McCluskie, McCormick, McLachlan, Michaelson Jenet, Parenti, Ricks, Sharbini, Sirota, Snyder, Story, Titone, Valdez, Velasco, Vigil, Weissman, Willford, Woodrow, Young SENATE SPONSORSHIP Roberts, Buckner, Coleman, Cutter, Danielson, Exum, Fenberg, Ginal, Hansen, Hinrichsen, Kolker, Marchman, Moreno, Priola, Sullivan, Winter F. Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters or bold & italic numbers indicate new material to be added to existing law. Dashes through the words or numbers indicate deletions from existing law. ! Have a prescription for an epinephrine auto-injector; and ! Are not enrolled in prescription drug coverage that limits the total amount of cost sharing that the enrollee is required to pay for an epinephrine auto-injector. The bill requires the division of insurance in the department of regulatory agencies (division) to create an application for the program and requires the division and the department of health care policy and financing to make the application available on their websites and to promote the availability of the program. The bill requires a carrier that provides coverage for prescription epinephrine auto-injectors to cap the total amount that a covered person is required to pay for all covered prescription epinephrine auto-injectors at an amount not to exceed $60 for a 2-pack of epinephrine auto-injectors. A pharmacy that dispenses epinephrine auto-injectors is authorized to collect a copayment not to exceed $60 from the individual to cover the pharmacy's costs of processing and dispensing a 2-pack of epinephrine auto-injectors. A manufacturer of epinephrine auto-injectors: ! Is required to make epinephrine auto-injectors available to individuals through the program; and ! May be required to reimburse the dispensing pharmacy an amount that covers the difference between the pharmacy's wholesale acquisition cost for the number of epinephrine auto-injectors dispensed through the program and the amount the recipients of the epinephrine auto-injectors paid for the same number of epinephrine auto-injectors or send the pharmacy a replacement supply of the same number of epinephrine auto-injectors. If a manufacturer fails to comply with the requirements of the bill, the manufacturer may be subject to a fine. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. Legislative declaration. (1) The general assembly2 finds and declares that:3 (a) Individuals who have moderate to severe allergies, severe4 asthma, or genetic conditions such as angioedema are at risk of reactions5 that can occur within seconds or minutes and that can lead to anaphylaxis,6 a potentially fatal reaction;7 (b) Epinephrine works quickly to improve breathing, stimulate the8 1002-2- heart, raise dropping blood pressure, prevent airways from closing,1 prevent or decrease shock, reverse hives, and reduce swelling of the face,2 lips, and throat;3 (c) Delay in appropriate treatment for anaphylaxis almost certainly4 contributes to death in individuals, so it is critical that all anaphylaxis5 reactions are treated as a medical emergency;6 (d) In Colorado, there are approximately 565,824 individuals with7 life-threatening food allergies, which is more than the population of8 Colorado Springs; of these individuals, 101,848 are under 18 years of age,9 which means that the number of children with food allergies in Colorado10 is larger than the population of Longmont;11 (e) Epinephrine auto-injectors are essential because they are the12 easiest and most efficient way to potentially save the life of an individual13 exhibiting symptoms of or experiencing anaphylactic shock;14 (f) Many individuals are unable to afford an epinephrine15 auto-injector because they cannnot pay the copayment amount required16 under their insurance plan or, if they are uninsured, the cost of an17 epinephrine auto-injector; these individuals risk their lives every day by18 not having access to this life-saving medicine if faced with an allergic19 reaction; and20 (g) Rising costs of epinephrine auto-injectors make this21 life-saving medication difficult or impossible to obtain for many people,22 even those with private health insurance or who are enrolled in a public23 health benefit program.24 (2) Therefore, it is the intent of the general assembly to establish25 an epinephrine auto-injector affordability program to ensure Colorado26 residents have greater access to epinephrine.27 1002 -3- SECTION 2. In Colorado Revised Statutes, add 10-16-158 as1 follows:2 10-16-158. Cost sharing - prescription epinephrine - limits -3 rules - definition. (1) A S USED IN THIS SECTION, UNLESS THE CONTEXT4 OTHERWISE REQUIRES, "EPINEPHRINE AUTO-INJECTOR" HAS THE SAME5 MEANING AS SET FORTH IN SECTION 12-280-141 (1)(c).6 (2) F OR HEALTH BENEFIT PLANS ISSUED OR RENEWED ON OR AFTER 7 J ANUARY 1, 2024, IF A CARRIER PROVIDES COVERAGE FOR PRESCRIPTION 8 EPINEPHRINE AUTO-INJECTORS, THE CARRIER SHALL CAP THE TOTAL9 AMOUNT THAT A COVERED PERSON IS REQUIRED TO PAY FOR ALL COVERED10 PRESCRIPTION EPINEPHRINE AUTO -INJECTORS AT AN AMOUNT NOT TO11 EXCEED SIXTY DOLLARS FOR A TWO -PACK OF EPINEPHRINE12 AUTO-INJECTORS, REGARDLESS OF THE AMOUNT OR TYPE OF EPINEPHRINE13 NEEDED TO FILL THE COVERED PERSON 'S PRESCRIPTION.14 (3) N OTHING IN THIS SECTION PREVENTS A CARRIER FROM15 REDUCING A COVERED PERSON 'S COST SHARING TO AN AMOUNT THAT IS16 LOWER THAN THE AMOUNT SPECIFIED IN SUBSECTION (2) OF THIS SECTION.17 (4) T HE COVERAGE REQUIRED BY THIS SECTION MAY BE OFFERED 18 THROUGH A HIGH DEDUCTIBLE PLAN THAT QUALIFIES FOR A HEALTH19 SAVINGS ACCOUNT PURSUANT TO 26 U.S.C. SEC. 223 OF THE FEDERAL20 "I NTERNAL REVENUE CODE OF 1986"; EXCEPT THAT A CARRIER MAY 21 APPLY DEDUCTIBLE AMOUNTS FOR THE REQUIRED COVERAGE IF THE22 COVERAGE IS NOT CONSIDERED BY THE UNITED STATES DEPARTMENT OF23 THE TREASURY TO BE PREVENTIVE OR TO HAVE AN ACCEPTABLE24 DEDUCTIBLE AMOUNT.25 (5) THE COMMISSIONER MAY USE ANY OF THE COMMISSIONER 'S26 ENFORCEMENT POWERS TO OBTAIN A CARRIER 'S COMPLIANCE WITH THIS27 1002 -4- SECTION.1 (6) THE COMMISSIONER MAY PROMULGATE RULES AS NECESSARY2 TO IMPLEMENT AND ADMINISTER THIS SECTION AND TO ALIGN WITH3 FEDERAL REQUIREMENTS.4 SECTION 3. In Colorado Revised Statutes, add 12-280-141 as5 follows:6 12-280-141. Epinephrine auto-injector affordability program7 - record keeping - reimbursement - definitions. (1) A S USED IN THIS8 SECTION:9 (a) "C ONSUMER PRICE INDEX " MEANS THE UNITED STATES10 DEPARTMENT OF LABOR'S BUREAU OF LABOR STATISTICS CONSUMER PRICE11 INDEX FOR DENVER-AURORA-LAKEWOOD FOR ALL ITEMS PAID BY ALL12 URBAN CONSUMERS , OR ITS APPLICABLE PREDECESSOR OR SUCCESSOR13 INDEX.14 (b) "D IVISION OF INSURANCE" MEANS THE DIVISION OF INSURANCE15 IN THE DEPARTMENT OF REGULATORY AGENCIES , CREATED IN SECTION16 10-1-103.17 (c) "E PINEPHRINE AUTO-INJECTOR" MEANS AN AUTOMATIC18 INJECTION DEVICE FOR INJECTING A MEASURED DOSE OF EPINEPHRINE19 BASED ON THE WEIGHT OF THE PERSON WHO IS TO RECEIVE THE INJECTION .20 (d) "M ANUFACTURER" MEANS A PERSON ENGAGED IN21 MANUFACTURING EPINEPHRINE AUTO -INJECTORS THAT ARE AVAILABLE22 FOR PURCHASE IN THIS STATE.23 (e) "P HARMACY" MEANS A PHARMACY OUTLET REGISTERED24 PURSUANT TO THIS ARTICLE 280 WHERE PRESCRIPTIONS ARE COMPOUNDED25 AND DISPENSED.26 (f) "P ROGRAM" MEANS THE EPINEPHRINE AUTO -INJECTOR27 1002 -5- AFFORDABILITY PROGRAM CREATED IN SUBSECTION (2) OF THIS SECTION.1 (g) "P ROOF OF RESIDENCY" MEANS A CURRENT AND VALID2 DOCUMENT THAT IS IN ENGLISH, OR IS TRANSLATED INTO ENGLISH AND IS3 UNALTERED, AND THAT INCLUDES THE INDIVIDUAL'S, OR IN THE CASE OF4 A MINOR, THE MINOR'S PARENT'S OR GUARDIAN'S, PRINTED NAME AND5 C OLORADO RESIDENTIAL ADDRESS . DOCUMENTS THAT MAY BE USED FOR6 PROOF OF RESIDENCY ARE:7 (I) A COLORADO-ISSUED DRIVER'S LICENSE OR COLORADO8 IDENTIFICATION CARD;9 (II) A PRINTED BILL, INCLUDING A UTILITY, TELEPHONE, INTERNET,10 CABLE, INSURANCE, MORTGAGE, RENT, WASTE DISPOSAL, WATER OR11 SEWER, MEDICAL, OR OTHER BILL;12 (III) A CREDIT CARD OR BANK STATEMENT ;13 (IV) A PAY STUB OR EARNINGS STATEMENT ;14 (V) A PIECE OF POST-MARKED FIRST-CLASS MAIL OR UNITED15 S TATES POSTAL SERVICE CHANGE OF ADDRESS CONFIRMATION ;16 (VI) A PRINTED RENT RECEIPT OR RESIDENTIAL LEASE;17 (VII) A TRANSCRIPT OR REPORT CARD FROM AN ACCREDITED18 SCHOOL;19 (VIII) A VEHICLE TITLE OR REGISTRATION;20 (IX) A N INSURANCE POLICY;21 (X) A GOVERNMENT-ISSUED LETTER OR STATE OR FEDERAL22 GOVERNMENT-ISSUED CHECK; OR23 (XI) A RECORD OF MEDICAL SERVICE FROM A SHELTER ,24 TREATMENT FACILITY, OR ASSISTED LIVING FACILITY , INCLUDING A25 HOMELESS SHELTER, WOMEN'S SHELTER, OTHER NONPROFIT SHELTER ,26 HALFWAY HOUSE, NURSING HOME, OR REHABILITATION FACILITY.27 1002 -6- 1 (2) (a) EFFECTIVE JANUARY 1, 2024, THE EPINEPHRINE2 AUTO-INJECTOR AFFORDABILITY PROGRAM IS CREATED TO PROVIDE3 LOW-COST EPINEPHRINE AUTO-INJECTORS TO ELIGIBLE INDIVIDUALS. BY4 J ANUARY 1, 2024, EACH MANUFACTURER SHALL ESTABLISH PROCEDURES5 TO AND SHALL MAKE EPINEPHRINE AUTO -INJECTORS AVAILABLE IN6 ACCORDANCE WITH THIS SECTION TO ELIGIBLE INDIVIDUALS WHO HOLD A7 VALID PRESCRIPTION FOR EPINEPHRINE AUTO -INJECTORS. THE 8 COMMISSIONER OF INSURANCE MAY DETERMINE THAT A MANUFACTURER9 MEETS THE REQUIREMENTS OF THIS SECTION IF THE MANUFACTURER :10 (I) H AS A PATIENT ASSISTANCE PROGRAM THAT HAS BEEN 11 REVIEWED AND APPROVED BY THE DIVISION ;12 (II) P ROVIDES COLORADO PATIENTS WITH EPINEPHRINE 13 AUTO-INJECTORS AT THE COST OF SIXTY DOLLARS OR LESS FOR EACH14 TWO-PACK OF EPINEPHRINE AUTO-INJECTORS; AND15 (III) C ONTINUES TO MAKE THE PATIENT ASSISTANCE PROGRAM 16 AVAILABLE TO COLORADO PATIENTS WHO MEET THE ELIGIBILITY CRITERIA17 OUTLINED IN SUBSECTION (3) OF THIS SECTION.18 (b) T HE COMMISSIONER OF INSURANCE SHALL DEVELOP A FORM 19 FOR MANUFACTURERS TO USE IN SEEKING SUCH DETERMINATION .20 (c) I F A MANUFACTURER DISCONTINUES ITS APPROVED PATIENT 21 ASSISTANCE PROGRAM , THE MANUFACTURER MUST IMMEDIATELY22 IMPLEMENT A PROGRAM TO COMPLY WITH THE REQUIREMENTS OF THIS23 SECTION FOR QUALIFYING COLORADO PATIENTS.24 (3) T O BE ELIGIBLE TO RECEIVE EPINEPHRINE AUTO -INJECTORS25 THROUGH THE PROGRAM , AN INDIVIDUAL MUST:26 (a) D EMONSTRATE PROOF OF RESIDENCY IN COLORADO;27 1002 -7- (b) NOT BE ELIGIBLE FOR ASSISTANCE PROVIDED THROUGH THE1 "C OLORADO MEDICAL ASSISTANCE ACT", ARTICLES 4 TO 6 OF TITLE 25.5,2 OR THE FEDERAL "HEALTH INSURANCE FOR THE AGED ACT", TITLE XVIII3 OF THE FEDERAL "SOCIAL SECURITY ACT", 42 U.S.C. SEC. 1395 ET SEQ.,4 AS AMENDED;5 (c) H AVE A VALID EPINEPHRINE AUTO-INJECTOR PRESCRIPTION;6 AND7 (d) N OT BE ENROLLED IN PRESCRIPTION DRUG COVERAGE THAT8 LIMITS THE TOTAL AMOUNT OF COST SHARING THAT THE ENROLLEE IS9 REQUIRED TO PAY FOR A COVERED PRESCRIPTION TO NOT MORE THAN10 SIXTY DOLLARS FOR A TWO -PACK OF EPINEPHRINE AUTO -INJECTORS,11 REGARDLESS OF THE AMOUNT OR TYPE OF EPINEPHRINE NEEDED TO FILL12 THE PRESCRIPTION.13 (4) (a) T HE DIVISION OF INSURANCE SHALL DEVELOP AN14 APPLICATION FORM TO BE USED BY AN INDIVIDUAL WHO IS SEEKING15 EPINEPHRINE AUTO-INJECTORS THROUGH THE PROGRAM . AT A MINIMUM,16 THE APPLICATION FORM MUST:17 (I) P ROVIDE INFORMATION RELATED TO PROGRAM ELIGIBILITY AND18 COVERAGE IN ENGLISH, SPANISH, AND IN EACH LANGUAGE SPOKEN BY AT19 LEAST TWO AND ONE-HALF PERCENT OF THE POPULATION OF ANY COUNTY20 IN WHICH SUCH POPULATION SPEAKS ENGLISH LESS THAN VERY WELL, AS21 DEFINED BY THE UNITED STATES BUREAU OF THE CENSUS AMERICAN22 COMMUNITY SURVEY OR COMPARABLE CENSUS DATA , AND SPEAKS A23 SHARED MINORITY LANGUAGE AT HOME ; AND24 (II) R EQUIRE THE INDIVIDUAL TO SHOW PROOF THAT THE25 INDIVIDUAL MEETS THE REQUIREMENTS OF SUBSECTION (3) OF THIS26 SECTION.27 1002 -8- (b) THE DIVISION OF INSURANCE AND THE DEPARTMENT OF HEALTH1 CARE POLICY AND FINANCING SHALL MAKE THE APPLICATION FORM2 AVAILABLE ON EACH AGENCY 'S WEBSITE. THE DIVISION OF INSURANCE3 SHALL ALSO MAKE THE APPLICATION FORM AVAILABLE TO PHARMACIES ,4 HEALTH-CARE PROVIDERS, AND HEALTH FACILITIES THAT PRESCRIBE OR5 DISPENSE EPINEPHRINE AUTO-INJECTORS.6 (5) T O ACCESS EPINEPHRINE AUTO -INJECTORS THROUGH THE7 PROGRAM, AN INDIVIDUAL MUST PRESENT , AT A PHARMACY , A8 COMPLETED, SIGNED, AND DATED APPLICATION FORM WITH PROOF OF9 RESIDENCY. IF THE INDIVIDUAL IS UNDER EIGHTEEN YEARS OF AGE , THE10 INDIVIDUAL'S PARENT OR LEGAL GUARDIAN MAY PROVIDE THE11 PHARMACIST WITH PROOF OF RESIDENCY .12 (6) (a) U PON RECEIPT OF AN INDIVIDUAL'S PROOF OF RESIDENCY13 AND COMPLETED , SIGNED, AND DATED APPLICATION FORM14 DEMONSTRATING THAT THE INDIVIDUAL IS ELIGIBLE PURSUANT TO15 SUBSECTION (3) OF THIS SECTION, A PHARMACIST SHALL DISPENSE THE16 PRESCRIBED EPINEPHRINE AUTO -INJECTORS. AN INDIVIDUAL WHO IS17 ELIGIBLE TO RECEIVE EPINEPHRINE AUTO -INJECTORS THROUGH THE18 PROGRAM MAY RECEIVE EPINEPHRINE AUTO -INJECTORS AS PRESCRIBED19 FOR TWELVE MONTHS.20 (b) T HE PHARMACIST IS ENCOURAGED TO INFORM THE INDIVIDUAL :21 (I) T HAT THE INDIVIDUAL MAY BE ELIGIBLE FOR MEDICAL22 ASSISTANCE PROGRAMS PURSUANT TO THE "COLORADO MEDICAL23 A SSISTANCE ACT", ARTICLES 4 TO 6 OF TITLE 25.5, OR AN AFFORDABLE24 INSURANCE PRODUCT ON THE HEALTH BENEFIT EXCHANGE CREATED IN25 SECTION 10-22-104; AND26 (II) O F ANY MANUFACTURER-SPONSORED PROGRAMS THAT ASSIST27 1002 -9- INDIVIDUALS WHO CANNOT AFFORD THEIR PRESCRIPTION EPINEPHRINE1 AUTO-INJECTORS.2 (c) T HE PHARMACIST SHALL RETAIN A COPY OF THE APPLICATION3 FORM SUBMITTED BY THE INDIVI DUAL FOR TWO YEARS AFTER THE DATE4 THE EPINEPHRINE AUTO-INJECTOR WAS INITIALLY DISPENSED.5 (7) A PHARMACY THAT DISPENSES EPINEPHRINE AUTO -INJECTORS6 PURSUANT TO SUBSECTION (6)(a) OF THIS SECTION MAY COLLECT A7 COPAYMENT FROM THE INDIVIDUAL TO COVER THE PHARMACY 'S COSTS OF8 PROCESSING AND DISPENSING THE EPINEPHRINE AUTO -INJECTOR, WHICH9 COPAYMENT AMOUNT MUST NOT EXCEED SIXTY DOLLARS FOR EACH10 TWO-PACK OF EPINEPHRINE AUTO -INJECTORS THAT THE PHARMACY11 DISPENSES TO THE INDIVIDUAL.12 (8) (a) E XCEPT AS PROVIDED IN SUBSECTION (8)(d) OF THIS13 SECTION, UNLESS THE MANUFACTURER AGREES TO SEND TO THE14 PHARMACY A REPLACEMENT SUPPLY OF THE SAME NUMBER OF15 EPINEPHRINE AUTO-INJECTORS DISPENSED THROUGH THE PROGRAM , THE16 PHARMACY MAY SUBMIT TO THE MANUFACTURER OF THE DISPENSED17 EPINEPHRINE AUTO -INJECTORS, DIRECTLY OR THROUGH THE18 MANUFACTURER'S DELEGATED REPRESENTATIVE , SUBCONTRACTOR, OR19 OTHER VENDOR, AN ELECTRONIC CLAIM FOR PAYMENT THAT IS MADE IN20 ACCORDANCE WITH THE NATIONAL COUNCIL FOR PRESCRIPTION DRUG21 P ROGRAMS' STANDARDS FOR ELECTRONIC CLAIMS PROCESSING .22 (b) B Y JANUARY 1, 2024, EACH MANUFACTURER SHALL DEVELOP23 A PROCESS FOR A PHARMACY TO SUBMIT AN ELECTRONIC CLAIM FOR24 REIMBURSEMENT, INCLUDING AN ACCESSIBLE ONLINE APPLICATION FOR25 REIMBURSEMENT CLAIMS FROM PHARMACIES UNDER THE PROGRAM, AS26 PROVIDED IN SUBSECTION (8)(a) OF THIS SECTION.27 1002 -10- (c) IF THE PHARMACY SUBMITS AN ELECTRONIC CLAIM TO THE1 MANUFACTURER PURSUANT TO SUBSECTION (8)(a) OF THIS SECTION, THE2 MANUFACTURER OR THE MANUFACTURER 'S DELEGATED REPRESENTATIVE,3 SUBCONTRACTOR, OR OTHER VENDOR SHALL, WITHIN THIRTY DAYS AFTER4 RECEIPT OF THE CLAIM, EITHER:5 (I) R EIMBURSE THE PHARMACY IN AN AMOUNT THAT THE 6 PHARMACY PAID FOR THE NUMBER OF EPINEPHRINE AUTO -INJECTORS7 DISPENSED THROUGH THE PROGRAM ; OR8 (II) S END THE PHARMACY A REPLACEMENT SUPPLY OF THE SAME 9 NUMBER OF EPINEPHRINE AUTO -INJECTORS IN AN AMOUNT EQUAL TO OR10 GREATER THAN THE NUMBER OF EPINEPHRINE AUTO -INJECTORS DISPENSED11 THROUGH THE PROGRAM PURSUANT TO SUBSECTION (6) OF THIS SECTION.12 (9) T HE DIVISION OF INSURANCE AND THE DEPARTMENT OF HEALTH13 CARE POLICY AND FINANCING SHALL PROMOTE THE AVAILABILITY OF THE14 PROGRAM TO COLORADANS. THE PROMOTIONAL MATERIAL MUST INCLUDE15 INFORMATION ABOUT EACH MANUFACTURER 'S CONSUMER EPINEPHRINE16 AUTO-INJECTOR PROGRAM, AS APPLICABLE. EACH AGENCY MAY SEEK AND17 ACCEPT GIFTS, GRANTS, AND DONATIONS TO FULFILL THE REQUIREMENTS18 OF THIS SUBSECTION (9).19 (10) A MANUFACTURER 'S REIMBURSEMENT PURSUANT TO20 SUBSECTION (8)(c) OF THIS SECTION IS NOT A KICKBACK.21 (11) A MANUFACTURER THAT FAILS TO COMPLY WITH THE22 REQUIREMENTS OF THIS SECTION:23 (a) IS SUBJECT TO A FINE OF TEN THOUSAND DOLLARS FOR EACH24 MONTH OF NONCOMPLIANCE ; AND25 (b) ENGAGES IN A DECEPTIVE TRADE PRACTICE UNDER SECTION26 6-1-105 (1)(uuu).27 1002 -11- SECTION 4. In Colorado Revised Statutes, 6-1-105, amend1 (1)(uuu) as follows:2 6-1-105. Unfair or deceptive trade practices. (1) A person3 engages in a deceptive trade practice when, in the course of the person's4 business, vocation, or occupation, the person:5 (uuu) FAILS TO COMPLY WITH THE REQUIREMENTS OF SECTION6 12-280-141.7 SECTION 5. Appropriation. For the 2023-24 state fiscal year,8 $77,632 is appropriated to the department of regulatory agencies for use9 by the division of insurance. This appropriation is from the division of10 insurance cash fund created in section 10-1-103 (3), C.R.S. To implement11 this act, the division may use this appropriation as follows:12 (a) $68,112 for personal services, which amount is based on an13 assumption that the division will require an additional 1.0 FTE; and14 (b) $9,520 for operating expenses.15 SECTION 6. Act subject to petition - effective date. This act16 takes effect at 12:01 a.m. on the day following the expiration of the17 ninety-day period after final adjournment of the general assembly; except18 that, if a referendum petition is filed pursuant to section 1 (3) of article V19 of the state constitution against this act or an item, section, or part of this20 act within such period, then the act, item, section, or part will not take21 effect unless approved by the people at the general election to be held in22 November 2024 and, in such case, will take effect on the date of the23 official declaration of the vote thereon by the governor.24 1002 -12-