First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0773.02 Kristen Forrestal x4217
HOUSE BILL 23-1201
House Committees Senate Committees
Health & Insurance
A BILL FOR AN ACT
C
ONCERNING PRESCRIPTION DRUG BENEFITS CONTRACT TERM101
REQUIREMENTS.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
.)
For group benefit plan contracts between a pharmacy benefit
manager (PBM) or a health insurance carrier (carrier) and an employer,
certificate holder, or policyholder, the bill requires that the amount
charged by the PBM or carrier to the employer, certificate holder, or
policyholder for a prescription drug be equal to or less than the amount
paid by the PBM or carrier to the contracted pharmacy for the drug.
HOUSE SPONSORSHIP
Daugherty and Soper,
SENATE SPONSORSHIP
(None),
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. The bill creates transparency requirements for PBMs and carriers
regarding prescription drug benefits and grants audit authority to the
department of health care policy and financing for self-funded plans and
to the commissioner of insurance for fully insured plans, on request of the
office of the attorney general, to ensure compliance with the
requirements.
A violation of the requirements of the bill is a deceptive trade
practice under the "Colorado Consumer Protection Act", with regard to
self-funded plans, and a deceptive trade practice in the business of
insurance, with regard to fully insured plans.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add part 16 to article2
1 of title 6 as follows:3
PART 164
PHARMACY BENEFIT MANAGER CONTRACTS5
6-1-1601. Definitions. A
S USED IN THIS PART 16, UNLESS THE6
CONTEXT OTHERWISE REQUIRES :7
(1) "B
ENEFICIARY" MEANS A PERSON ENTITLED TO RECEIVE8
HEALTH BENEFITS OR SERVICES UNDER AN EMPLOYER -SPONSORED PLAN.9
(2) "C
ARRIER" MEANS ANY ENTITY THAT OFFERS HEALTH10
COVERAGE IN THIS STATE.11
(3) "C
ONTRACTED PHARMACY " MEANS A PHARMACY THAT HAS12
CONTRACTED WITH A CARRIER , A PHARMACY BENEFIT MANAGER , OR AN13
AFFILIATE OF THE CARRIER OR PBM.14
(4) "D
EPARTMENT" MEANS THE DEPARTMENT OF HEALTH CARE15
POLICY AND FINANCING.16
(5) "E
MPLOYER-SPONSORED PLAN" MEANS A PLAN THAT PROVIDES17
FOR HEALTH BENEFITS, INCLUDING PLANS THAT ARE CLASSIFIED AS18
SELF-INSURED OR INSURED OR REGULATED BY THE FEDERAL "EMPLOYEE19
R
ETIREMENT INCOME SECURITY ACT", 29 U.S.C. 1001, ET SEQ., OFFERED20
HB23-1201-2- BY:1
(a) A
PERSON, TAFT-HARTLEY TRUST, MUNICIPALITY, STATE, OR2
LABOR UNION;3
(b) A
NY PLAN SPONSOR, INCLUDING AN EMPLOYER; OR4
(c) A
N EMPLOYER COALITION OR AGGREGATION OF EMPLOYERS5
WORKING TOGETHER TO NEGOTIATE IMPROVED CONTRACT TERMS WITH A6
PHARMACY BENEFIT MANAGER .7
(6) "I
NGREDIENT COST" MEANS THE ACTUAL AMOUNT PAID TO A8
PHARMACY BY A PHARMACY BENEFIT MANAGER FOR A PRESCRIPTION9
DRUG, NOT INCLUDING A DISPENSING FEE OR PATIENT COST -SHARING10
AMOUNT.11
(7) "P
ERSON" MEANS AN INDIVIDUAL, CORPORATION, BUSINESS12
TRUST, ESTATE, TRUST, PARTNERSHIP, UNINCORPORATED ASSOCIATION, OR13
TWO OR MORE OF SUCH ENTITIES HAVING A JOINT OR COMMON INTEREST ,14
OR ANY OTHER LEGAL OR COMMERCIAL ENTITY .15
(8) "P
HARMACY" MEANS AN ENTITY WHERE MEDICINAL DRUGS ARE16
DISPENSED AND SOLD, INCLUDING A RETAIL PHARMACY , MAIL-ORDER17
PHARMACY, SPECIALTY PHARMACY, HOSPITAL OUTPATIENT SETTING, OR18
OTHER RELATED PHARMACY .19
(9) "P
HARMACY BENEFIT MANAGEMENT " MEANS:20
(a) A
RRANGING TO PROCURE PRESCRIPTION DRUGS AT A21
NEGOTIATED RATE FOR DISPENSATION WITHIN THIS STATE TO22
BENEFICIARIES; AND23
(b) A
DMINISTERING OR MANAGING PRESCRIPTION DRUG BENEFITS24
INCLUDING PHARMACY NETWORK CONTRACTING , CLAIMS PROCESSING AND25
MANAGEMENT, AND PAYMENT OF CLAIMS TO PHARMACIES FOR26
PRESCRIPTION DRUGS DISPENSED TO BENEFICIARIES .27
HB23-1201
-3- (10) "PHARMACY BENEFIT MANAGER " OR "PBM" MEANS AN1
ENTITY THAT PERFORMS ANY ASPECT OF PHARMACY BENEFIT2
MANAGEMENT. "PHARMACY BENEFIT MANAGER " OR "PBM" INCLUDES:3
(a) A
PERSON IN A CONTRACTUAL, EMPLOYMENT, AFFILIATE, OR4
OWNERSHIP RELATIONSHIP WITH AN ENTITY PERFORMING PHARMACY5
BENEFIT MANAGEMENT , AS WELL AS THE CONTRACTING PARTY FOR THE6
PHARMACY BENEFIT MANAGER AND ITS AFFILIATES , IF APPLICABLE; AND7
(b) A
NY OTHER AFFILIATE CONTRACTING WITH A CONTRACTED8
EMPLOYER TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES .9
(11) "T
AFT-HARTLEY TRUST" MEANS A MULTI-EMPLOYER, JOINTLY10
MANAGED BENEFIT TRUST SPONSORED BY JOINT BOARDS OF BOTH LABOR11
AND MANAGEMENT TRUSTEES REPRESENTING PARTICIPANTS FROM MANY12
ORGANIZATIONS, USUALLY WITHIN THE SAME INDUSTRIES OR LABOR13
UNION.14
6-1-1602. Pharmacy benefit managers - contract terms -15
transparency requirements - rules. (1) F
OR A CONTRACT BETWEEN A16
PHARMACY BENEFIT MANAGER OR ITS CARRIER AFFILIATE AND A PERSON17
OFFERING AN EMPLOYER-SPONSORED PLAN THAT IS ISSUED OR RENEWED18
ON OR AFTER JANUARY 1, 2025, THE AMOUNT CHARGED BY THE CARRIER19
OR PBM TO THE PERSON OFFERING AN EMPLOYER -SPONSORED PLAN FOR20
A PRESCRIPTION DRUG DISPENSED TO A BENEFICIARY MUST BE EQUAL TO21
OR LESS THAN THE AMOUNT PAID BY THE CARRIER OR PBM TO A22
CONTRACTED PHARMACY FOR SUCH PRESCRIPTION DRUG DISPENSED TO23
SUCH BENEFICIARY RESIDING IN COLORADO.24
(2) (a) A
CARRIER OR PHARMACY BENEFIT MANAGER SHALL25
DISCLOSE TO EACH EMPLOYER THAT HAS A CONTRACT IN EFFECT WITH THE26
CARRIER OR PBM AT ANY TIME DURING CALE NDAR YEAR 2025 THE27
HB23-1201
-4- PRESCRIPTION DRUG CONTRACT TERMS REQUIRED BY THIS SUBSECTION (2).1
F
OR CONTRACTS IN EFFECT DURING CALENDAR YEAR 2023 OR 2024, OR2
BOTH, THE DISCLOSURE MUST ALSO INCLUDE ANY CHANGES IN TERMS3
BETWEEN EACH CALENDAR YEAR .4
(b) T
HE DISCLOSURES PURSUANT TO THIS SUBSECTION (2) MUST5
INCLUDE:6
(I) T
HE INGREDIENT COST AVERAGE REIMBURSEMENT RATE FOR :7
(A) G
ENERIC DRUGS DISPENSED AT RETAIL PHARMACIES ;8
(B) B
RAND-NAME DRUGS DISPENSED AT RETAIL PHARMACIES ;9
(C) S
PECIALTY DRUGS DISPENSED AT RETAIL PHARMACIES ;10
(D) G
ENERIC DRUGS DISPENSED AT MAIL-ORDER PHARMACIES;11
(E) B
RAND-NAME DRUGS DISPENSED AT MAIL-ORDER PHARMACIES;12
(F) S
PECIALTY DRUGS DISPENSED AT MAIL -ORDER PHARMACIES;13
AND14
(G) S
PECIALTY DRUGS DISPENSED AT ANY SPECIALTY PHARMACY ,15
INCLUDING A PHARMACY THAT IS FULLY OR PARTIALLY OWNED BY A16
CONTRACTING PBM, CARRIER, OR THE PBM'S OR CARRIER'S HOLDING17
COMPANIES OR AFFILIATES;18
(II) T
HE AVERAGE DISPENSING FEE PAID TO EACH TYPE OF19
PHARMACY, INCLUDING RETAIL , MAIL-ORDER, AND SPECIALTY20
PHARMACIES;21
(III) T
HE CHARGE PER PRIOR AUTHORIZATION ;22
(IV) U
TILIZATION MANAGEMENT PROGRAMS AND ASSOCIATED23
FEES;24
(V) A
NY OTHER CONTRACTED SERVICES AND ASSOCIATED FEES ;25
(VI) T
HE AVERAGE REBATE PER PRESCRIPTION AND PER26
REBATABLE PRESCRIPTION; AND27
HB23-1201
-5- (VII) THE REBATE GUARANTEE, WHERE APPLICABLE.1
(c) F
OR CONTRACTS BETWEEN A CARRIER OR PHARMACY BENEFIT2
MANAGER AND AN EMPLOYER THAT ARE RENEWED IN CALENDAR YEAR3
2025,
THE CARRIER OR PBM SHALL CALCULATE AND COMMUNICATE TO4
THE EMPLOYER THE VALUE OF THE DIFFERENCE BETWEEN THE CONTRACT5
TERMS IN THE 2025 RENEWED CONTRACTS AND THE CONTRACTS THAT6
WERE IN EFFECT IN CALENDAR YEAR 2024, ANNUALIZING THE FIRST SIX7
MONTHS OF 2024 ACTUAL DATA FOR EACH RESPECTIVE EMPLOYER . THE8
VALUE COMMUNICATED SHALL INCLUDE ANNUAL AGGREGATE SAVINGS ,9
ANNUAL AGGREGATE SAVINGS PER EMPLOYEE PER YEAR , AND ANNUAL10
AGGREGATE SAVINGS PER BENEFICIARY PER YEAR .11
(d) A
CARRIER OR PHARMACY BENEFIT MANAGER SHALL PROVIDE12
TO EACH EMPLOYER , FOR VOLUNTARY CONSIDERATION , OPTIONS TO13
REPURPOSE AGGREGATE SAVINGS IN THE FORM OF REDUCTIONS TO14
OUT-OF-POCKET COSTS SUCH AS DEDUCTIBLES , COPAYMENT AMOUNTS ,15
COINSURANCE, OR PREMIUM CONTRIBUTIONS . THE CARRIER OR PBM16
SHALL PROVIDE THE INFORMATION TO EMPLOYERS NO LESS THAN NINETY17
DAYS BEFORE THE DATE OF THE CALENDAR YEAR 2025 CONTRACT18
RENEWAL.19
(e) A
CARRIER OR PBM SHALL PROVIDE THE INFORMATION20
SPECIFIED IN SUBSECTIONS (2)(b), (2)(c), AND (2)(d) OF THIS SECTION TO21
ALL CONTRACTED EMPLOYERS FOR CONTRACTS IN EFFECT DURING22
CALENDAR YEAR 2025, INCLUDING CONTRACTED EMPLOYERS THAT MAY23
NOT RECEIVE A RENEWAL NOTICE DUE TO A MULTIYEAR CONTRACTUAL24
AGREEMENT OR FOR ANY OTHER REASON , EXCEPT NOTICE OF25
TERMINATION.26
(3) T
HE EXECUTIVE DIRECTOR OF THE DEPARTMENT SHALL , IN27
HB23-1201
-6- ACCORDANCE WITH THE "STATE ADMINISTRATIVE PROCEDURE ACT",1
ARTICLE 4 OF TITLE 24, PROMULGATE RULES TO IMPLEMENT SUBSECTION2
(2)
OF THIS SECTION.3
6-1-1603. Audits - rules. (1) T
HE OFFICE OF THE ATTORNEY4
GENERAL MAY REQUEST THE DEPARTMENT TO CONDUCT AN AUDIT OF A5
CARRIER OR PHARMACY BENEFIT MANAGER TO ENSURE COMPLIANCE WITH6
THIS PART 16. THE EXECUTIVE DIRECTOR OF THE DEPARTMENT OR THE7
EXECUTIVE DIRECTOR'S DESIGNEE, IN COLLABORATION WITH THE DIVISION8
OF INSURANCE, AS APPROPRIATE, MAY AUDIT, PURSUANT TO RULES9
PROMULGATED BY THE EXECUTIVE DIRECTOR OF THE DEPARTMENT , A10
CARRIER OR PBM TO DETERMINE IF THERE IS A VIOLATION OF THIS PART11
16.12
(2) T
HE DEPARTMENT MAY DETERMINE A CARRIER 'S OR PBM'S13
COMPLIANCE WITH THIS PART 16 BASED ON A SAMPLING OF DATA OR14
BASED ON A FULL AUDIT OF ALL HEALTH BENEFIT CLAIMS . THE SAMPLING15
OF DATA AND ANY EXTRAPOLATION FROM THE DATA USED TO DETERMINE16
PENALTIES MUST BE REASONABLY VALID FROM A STATISTICAL17
STANDPOINT AND IN ACCORDANCE WITH GENERALLY ACCEPTED AUDITING18
STANDARDS. ANY CARRIER OR PBM THAT DOES NOT COMPLY WITH A19
DEPARTMENT REQUEST FOR THE DAT A REQUIRED TO COMPLETE AN AUDIT20
VIOLATES THIS PART 16 AND MAY BE PENALIZED FOR EACH DATA ELEMENT21
MISSING FROM THE RESPONSE TO THE REQUEST .22
(3) I
NFORMATION OBTAINED THROUGH AN AUDIT CONDUCTED23
PURSUANT TO THIS SECTION IS CONSIDERED PROPRIETARY AND24
CONFIDENTIAL INFORMATION, AVAILABLE ONLY TO THE DEPARTMENT, THE25
COMMISSIONER OF INSURANCE , THEIR AUDIT DESIGNEES , AND THE26
ATTORNEY GENERAL 'S OFFICE, AND IS NOT SUBJECT TO DISCLOSURE27
HB23-1201
-7- UNLESS SPECIFICALLY REQUIRED BY STATE OR FEDERAL LAW .1
6-1-1604. Unfair or deceptive trade practice - enforcement. A2
VIOLATION OF THIS PART 16 IS AN UNFAIR OR DECEPTIVE TRADE PRACTICE3
AND SHALL BE ENFORCED BY THE ATTORNEY GENERAL , WHO HAS ALL4
POWERS AND AUTHORITY GRANTED IN SECTIONS 6-1-107 TO 6-1-113 FOR5
THE PURPOSES OF ENFORCING THIS PART 16.6
SECTION 2. In Colorado Revised Statutes, add 10-16-158 as7
follows:8
10-16-158. Contracts - health benefit plans - pharmacy benefit9
managers - policyholders - transparency requirements - rules -10
definitions. (1) F
OR A CONTRACT BETWEEN A CARRIER OR PHARMACY11
BENEFIT MANAGER AND A CERTIFICATE HOLDER OR POLICYHOLDER THAT12
IS ISSUED OR RENEWED ON OR AFTER JANUARY 1, 2025, THE AMOUNT13
CHARGED BY THE CARRIER OR PBM TO THE CERTIFICATE HOLDER OR14
POLICYHOLDER FOR A PRESCRIPTION DRUG DISPENSED TO A COVERED15
PERSON MUST BE EQUAL TO OR LESS THAN THE AMOUNT PAID BY THE16
CARRIER OR PBM TO A CONTRACTED PHARMACY FOR SUCH PRESCRIPTION17
DRUG DISPENSED TO SUCH COVERED PERSON RESIDING IN COLORADO.18
(2) (a) F
OR GROUP HEALTH BENEFIT PLANS IN EFFECT DURING19
CALENDAR YEAR 2025, A CARRIER OR PHARMACY BENEFIT MANAGER20
SHALL DISCLOSE TO EACH CERTIFICATE HOLDER OR POLICYHOLDER THE21
PRESCRIPTION DRUG CONTRACT TERMS REQUIRED BY THIS SUBSECTION (2).22
F
OR GROUP HEALTH BENEFIT PLANS IN EFFECT DURING CALENDAR YEAR23
2023
OR 2024, OR BOTH, THE DISCLOSURE MUST ALSO INCLUDE ANY24
CHANGES IN TERMS BETWEEN EACH CALENDAR YEAR .25
(b) T
HE DISCLOSURES PURSUANT TO THIS SUBSECTION (2) MUST26
INCLUDE:27
HB23-1201
-8- (I) THE INGREDIENT COST AVERAGE REIMBURSEMENT RATE FOR :1
(A) G
ENERIC DRUGS DISPENSED AT RETAIL PHARMACIES ;2
(B) B
RAND-NAME DRUGS DISPENSED AT RETAIL PHARMACIES ;3
(C) S
PECIALTY DRUGS DISPENSED AT RETAIL PHARMACIES ;4
(D) G
ENERIC DRUGS DISPENSED AT MAIL-ORDER PHARMACIES;5
(E) B
RAND-NAME DRUGS DISPENSED AT MAIL-ORDER PHARMACIES;6
(F) S
PECIALTY DRUGS DISPENSED AT MAIL -ORDER PHARMACIES;7
AND8
(G) S
PECIALTY DRUGS DISPENSED AT ANY SPECIALTY PHARMACY ,9
INCLUDING A PHARMACY THAT IS FULLY OR PARTIALLY OWNED BY A10
CONTRACTING PBM, CARRIER, OR THE PBM'S OR CARRIER'S HOLDING11
COMPANIES OR AFFILIATES;12
(II) T
HE AVERAGE DISPENSING FEE PAID TO EACH TYPE OF13
PHARMACY, INCLUDING EACH RETAIL , MAIL-ORDER, AND SPECIALTY14
PHARMACY;15
(III) T
HE CHARGE PER PRIOR AUTHORIZATION ;16
(IV) U
TILIZATION MANAGEMENT PROGRAMS AND ASSOCIATED17
FEES;18
(V) A
NY OTHER CONTRACTED SERVICES AND ASSOCIATED FEES ;19
(VI) T
HE AVERAGE REBATE PER PRESCRIPTION AND PER20
REBATABLE PRESCRIPTION; AND21
(VII) T
HE REBATE GUARANTEE, WHERE APPLICABLE.22
(c) F
OR CONTRACTS BETWEEN A CARRIER OR PHARMACY BENEFIT23
MANAGER AND A CERTIFICATE HOLDER OR POLICYHOLDER THAT ARE24
RENEWED IN CALENDAR YEAR 2025, THE CARRIER OR PBM SHALL25
CALCULATE AND COMMUNICATE TO THE CERTIFICATE HOLDER OR26
POLICYHOLDER THE VALUE OF THE DIFFERENCE BETWEEN THE CONTRACT27
HB23-1201
-9- TERMS IN THE 2025 RENEWED CONTRACTS AND THE CONTRACTS THAT1
WERE IN EFFECT IN CALENDAR YEAR 2024, ANNUALIZING THE FIRST SIX2
MONTHS OF 2024 ACTUAL DATA FOR EACH RESPECTIVE CERTIFICATE3
HOLDER OR POLICYHOLDER. THE VALUE COMMUNICATED SHALL INCLUDE4
ANNUAL AGGREGATE SAVINGS , ANNUAL AGGREGATE SAVINGS PER5
EMPLOYEE PER YEAR, AND ANNUAL AGGREGATE SAVINGS PER COVERED6
PERSON PER YEAR.7
(d) A
CARRIER OR PHARMACY BENEFIT MANAGER SHALL PROVIDE8
TO EACH CERTIFICATE HOLDER OR POLICYHOLDER , FOR VOLUNTARY9
CONSIDERATION, OPTIONS TO REPURPOSE AGGREGATE SAVINGS IN THE10
FORM OF REDUCTIONS TO OUT-OF-POCKET COSTS SUCH AS DEDUCTIBLES ,11
COPAYMENT AMOUNTS , COINSURANCE, OR PREMIUM CONTRIBUTIONS. THE12
CARRIER OR PBM SHALL PROVIDE THE INFORMATION TO CERTIFICATE13
HOLDERS OR POLICYHOLDERS NO LESS THAN NINETY DAYS BEFORE THE14
DATE OF THE CALENDAR YEAR 2025 CONTRACT RENEWAL.15
(e) A
CARRIER OR PBM SHALL PROVIDE THE INFORMATION16
SPECIFIED IN SUBSECTIONS (2)(b), (2)(c), AND (2)(d) OF THIS SECTION TO17
ALL CERTIFICATE HOLDERS AND POLICYHOLDERS FOR CONTRACTS IN18
EFFECT DURING CALENDAR YEAR 2025, INCLUDING CERTIFICATE HOLDERS19
AND POLICYHOLDERS THAT MAY NOT RECEIVE A RENEWAL NOTICE DUE TO20
A MULTIYEAR CONTRACTUAL AGREEMENT OR FOR ANY OTHER REASON ,21
EXCEPT NOTICE OF TERMINATION.22
(3) T
HE COMMISSIONER, IN COLLABORATION WITH THE EXECUTIVE23
DIRECTOR OF THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING ,24
SHALL PROMULGATE RULES TO IMPLEMENT THIS SECTION .25
(4) (a) T
HE COMMISSIONER MAY CONDUCT AN AUDIT OR MARKET26
CONDUCT EXAMINATION OF A CARRIER OR PHARMACY BENEFIT MANAGER27
HB23-1201
-10- TO ENSURE COMPLIANCE WITH THIS SECTION AND MAY , AS APPROPRIATE,1
CONDUCT THE AUDIT OR MARKET C ONDUCT EXAMINATION IN2
CONJUNCTION WITH THE DEPARTMENT OF HEALTH CARE POLICY AND3
FINANCING. THE COMMISSIONER, PURSUANT TO ANY RULES PROMULGATED4
BY THE DIVISION IN COLLABORATION WITH THE EXECUTIVE DIRECTOR OF5
THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING , AS6
APPROPRIATE, MAY AUDIT A CARRIER OR PBM ANNUALLY TO DETERMINE7
IF THERE IS A VIOLATION OF THIS SECTION.8
(b) T
HE COMMISSIONER MAY DETERMINE A CARRIER 'S OR PBM'S9
COMPLIANCE WITH THIS SECTION BASED ON A SAMPLING OF DATA OR10
BASED ON A FULL CLAIMS AUDIT . THE SAMPLING OF DATA AND ANY11
EXTRAPOLATION FROM THE DATA USED TO DETERMINE PENALTIES MUST12
BE REASONABLY VALID FROM A STATISTICAL STANDPOINT AND IN13
ACCORDANCE WITH GENERALLY ACCEPTED AUDITING STANDARDS . A14
CARRIER OR PBM THAT DOES NOT COMPLY WITH A DIVISION REQUEST FOR15
THE DATA REQUIRED TO COMPLETE AN AUDIT VIOLATES THIS SECTION AND16
MAY BE SUBJECT TO PENALTIES.17
(c) I
NFORMATION OBTAINED THROUGH AN AUDIT CONDUCTED18
PURSUANT TO THIS SUBSECTION (4) IS PROPRIETARY AND CONFIDENTIAL19
INFORMATION, AVAILABLE ONLY TO THE DEPARTMENT OF HEALTH CARE20
POLICY AND FINANCING, THE COMMISSIONER, THEIR AUDITING DESIGNEES,21
AND THE ATTORNEY GENERAL 'S OFFICE, AND IS NOT SUBJECT TO22
DISCLOSURE UNLESS SPECIFICALLY REQUIRED BY STATE OR FEDERAL LAW .23
(5) T
HE FAILURE OF A CARRIER OR PBM TO COMPLY WITH THIS24
SECTION IS AN UNFAIR METHOD OF COMPETITION AND AN UNFAIR OR A25
DECEPTIVE ACT OR PRACTICE IN THE BUSINESS OF INSURANCE PURSUANT26
TO SECTION 10-3-1104 (1).27
HB23-1201
-11- (6) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE1
REQUIRES:2
(a) "C
ONTRACTED PHARMACY " MEANS A PHARMACY THAT HAS3
CONTRACTED WITH A CARRIER , A PHARMACY BENEFIT MANAGER , OR AN4
AFFILIATE OF THE CARRIER OR PBM.5
(b) "I
NGREDIENT COST" MEANS THE ACTUAL AMOUNT PAID TO A6
PHARMACY BY A PHARMACY BENEFIT MANAGER FOR A PRESCRIPTION7
DRUG, NOT INCLUDING A DISPENSING FEE OR PATIENT COST -SHARING8
AMOUNT.9
(c) "P
HARMACY" MEANS AN ENTITY WHERE MEDICINAL DRUGS ARE10
DISPENSED AND SOLD, INCLUDING A RETAIL PHARMACY , MAIL-ORDER11
PHARMACY, SPECIALTY PHARMACY, HOSPITAL OUTPATIENT SETTING, OR12
OTHER RELATED PHARMACY .13
SECTION 3. Act subject to petition - effective date. This act14
takes effect at 12:01 a.m. on the day following the expiration of the15
ninety-day period after final adjournment of the general assembly; except16
that, if a referendum petition is filed pursuant to section 1 (3) of article V17
of the state constitution against this act or an item, section, or part of this18
act within such period, then the act, item, section, or part will not take19
effect unless approved by the people at the general election to be held in20
November 2024 and, in such case, will take effect on the date of the21
official declaration of the vote thereon by the governor.22
HB23-1201
-12-