First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 25-0494.01 Josh Schultz x5486
HOUSE BILL 25-1222
House Committees Senate Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING MEASURES TO PRESERVE HEALTH -CARE ACCESS101
PROVIDED BY RURAL INDEPENDENT PHARMACIES .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
.)
The bill prevents a pharmacy benefit manager (PBM) from
prohibiting a rural independent pharmacy from using a private courier or
a delivery service to deliver a prescription drug to a patient.
A PBM is required to reimburse a rural independent pharmacy for
a prescription drug in an amount not less than the average acquisition cost
for like prescription drugs, as determined by the medical services board
HOUSE SPONSORSHIP
Winter T. and Lukens, Armagost, Boesenecker, Johnson, Mauro, Zokaie
SENATE SPONSORSHIP
Roberts and Simpson, Baisley, Bright, Catlin, Hinrichsen, Jaquez Lewis, Kipp, Kolker,
Marchman, Pelton R., Rich, Snyder
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. in the state department of health care policy and financing, plus pay a
dispensing fee.
When a PBM conducts an audit of a rural independent pharmacy
and the audit results in a recoupment of more than $1,000 or a penalty of
more than $1,000, the PBM must serve process on the rural independent
pharmacy and notify the rural independent pharmacy of the rural
independent pharmacy's appeal rights at least 30 days before any
recoupment of funds.
The bill defines "flex pharmacy" as a prescription drug outlet that:
! Is registered with the state board of pharmacy (board) as a
prescription drug outlet;
! Operates as a telepharmacy during times when the licensed
pharmacist is not on the premises;
! Has a licensed pharmacist on the premises for at least twice
the number of hours that the flex pharmacy operates as a
telepharmacy;
! Operates as a telepharmacy from the same premises as the
premises where the pharmacy is registered; and
! Is a rural independent pharmacy.
The board may adopt rules to facilitate the operation of flex
pharmacies and may assess a fee on a prescription drug outlet applying to
be a flex pharmacy.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds and determines that:3
(a) Rural independent pharmacies are critical to the provision of4
health-care services for Colorado's rural communities and vulnerable5
populations;6
(b) Nationally, one in 3 pharmacies have closed in the last decade;7
(c) A 2024 study of pharmacy closures found that 41% of the8
state's pharmacy closures were independent pharmacies, with the majority9
of those closures located in rural areas of the state;10
(d) Rural independent pharmacies have higher rates of permanent11
closure and report low reimbursement rates from pharmacy benefit12
managers, or "PBMs", as the key contributing factor;13
HB25-1222-2- (e) Nationally, PBMs are under scrutiny for restricting consumer1
choice, steering patients to select pharmacies, and reimbursing rural2
independent pharmacies below cost;3
(f) State attorneys general have sued PBMs for over-inflating4
prescription drug costs for state medicaid programs, and the over-inflated5
prescription drug costs drive up costs for taxpayers by hundreds of6
millions of dollars;7
(g) The federal house committee on oversight and accountability8
found that the 3 largest PBMs control 80% of the market and have used9
their position to enact anticompetitive policies, share patient information,10
steer patients to PBM-owned pharmacies, and artificially reduce11
reimbursements to rural independent pharmacies;12
(h) The federal trade commission has reported that PBM practices13
inflate drug costs, squeeze independent pharmacies, and deprive14
consumers of affordable, accessible health care;15
(i) A recent audit by the state of Mississippi found that PBMs16
excessively audited pharmacies and reimbursed rural independent17
pharmacies 145% less than they paid their own PBM-affiliated pharmacy18
for the same drug;19
(j) Rural independent pharmacies offer a wide variety of20
health-care services, ranging from prescription drug delivery; special drug21
packaging for vulnerable populations; medication management; wellness22
and prevention services; immunizations; chronic and acute care23
management; testing and treatment for strep throat, flu, and COVID-19;24
blood pressure and glucose screenings; and diabetes education and25
management, and provide health-care services for hospitals, long-term26
care facilities, and health clinics; and27
HB25-1222
-3- (k) When rural independent pharmacies close, patients lose access1
to care, communities lose health-care providers, and Coloradans are2
forced to travel greater distances to access care or are left completely3
without care.4
(2) Therefore, the general assembly declares that Colorado must5
preserve access to rural independent pharmacies for the state's rural6
communities and its most vulnerable populations.7
SECTION 2. In Colorado Revised Statutes, 10-16-102, add8
(59.5) as follows:9
10-16-102. Definitions. As used in this article 16, unless the10
context otherwise requires:11
(59.5) "R
URAL INDEPENDENT PHARMACY " MEANS A PRESCRIPTION12
DRUG OUTLET THAT IS:13
(a) P
RIVATELY OWNED BY AT LEAST ONE LICENSED PHARMACIST14
WITH NO OWNERSHIP INTEREST BY OR AFFILIATION WITH A CHAIN15
PHARMACY OR A PUBLICLY TRADED PRESCRIPTION DRUG OUTLET ; OR16
(b) L
OCATED IN A COUNTY WITH A POPULATION OF LESS THAN17
FIFTY THOUSAND RESIDENTS OR A MUNICIPALITY WITH A POPULATION OF18
LESS THAN TWENTY-FIVE THOUSAND RESIDENTS IF THE MUNICIPALITY IS19
NOT CONTIGUOUS TO A MUNICIPALITY WITH A POPULATION OF20
TWENTY-FIVE THOUSAND OR MORE RESIDENTS .21
SECTION 3. In Colorado Revised Statutes, 10-16-122.1, amend22
(3) introductory portion; and add (3)(d) as follows:23
10-16-122.1. Contracts between PBMs and pharmacies -24
carrier submit list of PBMs - PBM registration - fees - prohibited25
practices - exception - rules - enforcement - short title - definitions.26
(3) Starting in 2022,
A PBM or the representative of a PBM shall not:27
HB25-1222
-4- (d) (I) PROHIBIT A RURAL INDEPENDENT PHARMACY FROM USING1
A PRIVATE COURIER OR A DELIVERY SERVICE TO DELIVER A PRESCRIPTION2
DRUG TO A PATIENT; OR3
(II) R
EQUIRE A RURAL INDEPENDENT PHARMACY TO OBTAIN4
CONSENT FROM THE PBM TO USE A PRIVATE COURIER OR DELIVERY5
SERVICE TO DELIVER A PRESCRIPTION DRUG TO A PATIENT .6
SECTION 4. In Colorado Revised Statutes, 10-16-122.3, add7
(1.5), (6)(a.5), and (6)(b.3) as follows:8
10-16-122.3. Pharmacy benefit management firm payments -9
retroactive reduction prohibited - enforcement - rules - definitions.10
(1.5) (a) A
PHARMACY BENEFIT MANAGEMENT FIRM SHALL REIMBURSE A11
RURAL INDEPENDENT PHARMACY FOR A PRESCRIPTION DRUG IN AN12
AMOUNT NOT LESS THAN THE AVERAGE ACQUISITION COST OF A13
PRESCRIPTION DRUG PLUS A DISPENSING FEE.14
(b) A
PHARMACY BENEFIT MANAGEMENT FIRM SHALL PAY A RURAL15
INDEPENDENT PHARMACY A DISPENSING FEE , WHICH FEE IS DETERMINED16
BY THE MEDICAL SERVICES BOARD IN THE STATE DEPARTMENT OF HEALTH17
CARE POLICY AND FINANCING , IN AN AMOUNT NOT LESS THAN THE18
DISPENSING FEE FOR RURAL PHARMACIES .19
(6) As used in this section:20
(a.5) "A
VERAGE ACQUISITION COST " MEANS THE AVERAGE21
ACQUISITION COST FOR LIKE PRESCRIPTION DRUGS, AS DETERMINED BY THE22
MEDICAL SERVICES BOARD IN THE STATE DEPARTMENT OF HEALTH CARE23
POLICY AND FINANCING.24
(b.3) (I) "D
ISPENSING FEE" MEANS THE REIMBURSEMENT AMOUNT25
FOR COSTS ASSOCIATED WITH FILLING A PRESCRIPTION, AS DETERMINED BY26
THE MEDICAL SERVICES BOARD IN THE STATE DEPARTMENT OF HEALTH27
HB25-1222
-5- CARE POLICY AND FINANCING.1
(II) F
OR THE PURPOSES OF DETERMINING THE DISPENSING FEE FOR2
A RURAL PHARMACY, THE DISPENSING FEE IS THE FEE CALCULATED BY THE3
MEDICAL SERVICES BOARD AS THE DISPENSING FEE FOR RURAL4
PHARMACIES.5
SECTION 5. In Colorado Revised Statutes, 10-16-122.5, amend6
(1)(e) and (1)(f); and add (1)(g) as follows:7
10-16-122.5. Pharmacy benefit manager - audit of pharmacies8
- time limits on on-site audits - enforcement - rules. (1) A pharmacy9
benefit manager, a carrier, or an entity acting on behalf of a pharmacy10
benefit manager or a carrier that audits a pharmacy shall:11
(e) Establish a written appeals process that includes procedures to12
allow a pharmacy to appeal to the pharmacy benefit manager or the13
carrier the preliminary reports resulting from the audit and any resulting14
recoupment or penalty; and
15
(f) Not subject a pharmacy to the recoupment of funds when an16
audit results in the identification of a clerical error in a required document17
or record unless the error results in actual financial harm to the pharmacy18
benefit manager, a health benefit plan providing prescription drug19
benefits that are managed by the pharmacy benefit manager, or a20
consumer;
AND21
(g) W
HEN SUBJECTING A RURAL INDEPENDENT PHARMACY TO A22
RECOUPMENT OF FUNDS , SERVE PROCESS ON THE RURAL INDEPENDENT23
PHARMACY AND NOTIFY THE RURAL INDEPENDENT PHARMACY OF THE24
RURAL INDEPENDENT PHARMACY 'S RIGHTS TO APPEAL PURSUANT TO25
SUBSECTION (1)(e) OF THIS SECTION AT LEAST THIRTY DAYS BEFORE THE26
RECOUPMENT OF FUNDS WHEN AN AUDIT RESULTS IN A RECOUPMENT OF27
HB25-1222
-6- MORE THAN ONE THOUSAND DOLLARS OR A PENALTY OF MORE THAN ONE1
THOUSAND DOLLARS.2
SECTION 6. In Colorado Revised Statutes, 12-280-103, add3
(17.5) and (46.7) as follows:4
12-280-103. Definitions - rules. As used in this article 280, unless5
the context otherwise requires or the term is otherwise defined in another6
part of this article 280:7
(17.5) "F
LEX PHARMACY" MEANS A PRESCRIPTION DRUG OUTLET8
THAT OPERATES AS A TELEPHARMACY WHEN THE LICENSED PHARMACIST9
IS NOT ON THE PREMISES.10
(46.7) "R
URAL INDEPENDENT PHARMACY " HAS THE MEANING SET11
FORTH IN SECTION 10-16-102 (59.5).12
SECTION 7. In Colorado Revised Statutes, add 12-280-118.5 as13
follows:14
12-280-118.5. Flex pharmacy - fee - supervision - rules.15
(1) T
HE BOARD MAY ADOPT RULES TO SPECIFY ADDITIONAL CRITERIA16
NECESSARY TO FACILITATE THE OPERATION OF FLEX PHARMACIES .17
(2) T
HE BOARD SHALL ASSESS A FEE ON A PRESCRIPTION DRUG18
OUTLET THAT APPLIES TO BE A FLEX PHARMACY SO THAT THE TOTAL FEE19
AMOUNT COLLECTED IS SUFFICIENT TO COVER THE DIRECT AND INDIRECT20
COSTS NECESSARY FOR THE BOARD TO FACILITATE THE OPERATION OF FLEX21
PHARMACIES.22
(3) A
FLEX PHARMACY:23
(a) S
HALL BE REGISTERED AS A PRESCRIPTION DRUG OUTLET OR24
PHARMACY UNDER THIS ARTICLE 280;25
(b) S
HALL HAVE A LICENSED PHARMACIST ON THE PREMISES FOR26
AT LEAST TWICE THE NUMBER OF HOURS PER CALENDAR YEAR THAT THE27
HB25-1222
-7- FLEX PHARMACY OPERATES AS A TELEPHARMACY ;1
(c) S
HALL OPERATE AS A TELEPHARMACY FROM THE SAME2
PREMISES AS THE PREMISES WHERE THE PHARMACY IS REGISTERED ; AND3
(d) M
UST BE A RURAL INDEPENDENT PHARMACY .4
(4) W
HEN A FLEX PHARMACY OPERATES AS A TELEPHARMACY , THE5
CENTRAL PHARMACY RESPONSIBLE FOR OVERSEEING THE OPERATION OF6
THE FLEX PHARMACY MUST BE AFFILIATED WITH THE FLEX PHARMACY7
THROUGH COMMON OWNERSHIP OR THROUGH A COMMON PROFESSIONAL8
PHARMACY ORGANIZATION THAT OFFERS SUPPORT FOR TELEPHARMACY9
SUPERVISION SERVICES.10
SECTION 8. Act subject to petition - effective date -11
applicability. (1) This act takes effect at 12:01 a.m. on the day following12
the expiration of the ninety-day period after final adjournment of the13
general assembly; except that, if a referendum petition is filed pursuant14
to section 1 (3) of article V of the state constitution against this act or an15
item, section, or part of this act within such period, then the act, item,16
section, or part will not take effect unless approved by the people at the17
general election to be held in November 2026 and, in such case, will take18
effect on the date of the official declaration of the vote thereon by the19
governor.20
(2) This act applies to conduct occurring on or after the applicable21
effective date of this act.22
HB25-1222
-8-