Colorado 2025 Regular Session

Colorado House Bill HB1222 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		First Regular Session
2	2		Seventy-fifth General Assembly
3	3		STATE OF COLORADO
4		-	~~REREVISED~~
5		-	This Version Includes All Amendments
6		-	~~Adopted~~ in the Second House
	4	+	REVISED
	5	+	This Version Includes All Amendments Adopted
	6	+	on Second Reading in the Second House
7	7		LLS NO. 25-0494.01 Josh Schultz x5486
8	8		HOUSE BILL 25-1222
9	9		House Committees Senate Committees
10	10		Health & Human Services Health & Human Services
11	11		A BILL FOR AN ACT
12	12		C
13	13		ONCERNING MEASURES TO PRESERVE HEALTH -CARE ACCESS101
14	14		PROVIDED BY RURAL INDEPENDENT PHARMACIES .102
15	15		Bill Summary
16	16		(Note: This summary applies to this bill as introduced and does
17	17		not reflect any amendments that may be subsequently adopted. If this bill
18	18		passes third reading in the house of introduction, a bill summary that
19	19		applies to the reengrossed version of this bill will be available at
20	20		http://leg.colorado.gov
21	21		.)
22	22		The bill prevents a pharmacy benefit manager (PBM) from
23	23		prohibiting a rural independent pharmacy from using a private courier or
24	24		a delivery service to deliver a prescription drug to a patient.
25	25		A PBM is required to reimburse a rural independent pharmacy for
26	26		a prescription drug in an amount not less than the average acquisition cost
27	27		for like prescription drugs, as determined by the medical services board
28	28		SENATE
29		-	3rd Reading Unamended
30		-	April 23, 2025
31		-	SENATE
32	29		Amended 2nd Reading
33	30		April 22, 2025
34	31		HOUSE
35	32		Amended 2nd Reading
36	33		March 20, 2025
37	34		HOUSE
38	35		3rd Reading Unamended
39	36		March 25, 2025
40	37		HOUSE SPONSORSHIP
41	38		Winter T. and Lukens, Armagost, Boesenecker, Johnson, Mauro, Zokaie, Bacon, Barron,
42	39		Bird, Bradley, Brown, Caldwell, Clifford, Duran, Espenoza, Froelich, Garcia Sander,
43	40		Gonzalez R., Hamrick, Joseph, Keltie, Mabrey, Marshall, Martinez, McCluskie, McCormick,
44	41		Paschal, Richardson, Rutinel, Soper, Stewart K., Story, Velasco, Weinberg
45	42		SENATE SPONSORSHIP
46	43		Roberts and Simpson, Baisley, Bright, Catlin, Hinrichsen, Kipp, Kolker, Marchman,
47		-	Pelton R., Rich, Snyder, Amabile, Ball, Bridges, Carson, Coleman, Cutter, Daugherty, Exum,
48		-	Frizell, Gonzales J., Jodeh, Kirkmeyer, Liston, Lundeen, Michaelson Jenet, Mullica, Pelton
49		-	B., Wallace, Weissman, Winter F.
	44	+	Pelton R., Rich, Snyder
50	45		Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
51	46		Capital letters or bold & italic numbers indicate new material to be added to existing law.
52	47		Dashes through the words or numbers indicate deletions from existing law. in the state department of health care policy and financing, plus pay a
53	48		dispensing fee.
54	49		When a PBM conducts an audit of a rural independent pharmacy
55	50		and the audit results in a recoupment of more than $1,000 or a penalty of
56	51		more than $1,000, the PBM must serve process on the rural independent
57	52		pharmacy and notify the rural independent pharmacy of the rural
58	53		independent pharmacy's appeal rights at least 30 days before any
59	54		recoupment of funds.
60	55		The bill defines "flex pharmacy" as a prescription drug outlet that:
61	56		! Is registered with the state board of pharmacy (board) as a
62	57		prescription drug outlet;
63	58		! Operates as a telepharmacy during times when the licensed
64	59		pharmacist is not on the premises;
65	60		! Has a licensed pharmacist on the premises for at least twice
66	61		the number of hours that the flex pharmacy operates as a
67	62		telepharmacy;
68	63		! Operates as a telepharmacy from the same premises as the
69	64		premises where the pharmacy is registered; and
70	65		! Is a rural independent pharmacy.
71	66		The board may adopt rules to facilitate the operation of flex
72	67		pharmacies and may assess a fee on a prescription drug outlet applying to
73	68		be a flex pharmacy.
74	69		Be it enacted by the General Assembly of the State of Colorado:1
75	70		SECTION 1. Legislative declaration. (1) The general assembly2
76	71		finds and determines that:3
77	72		(a) Rural independent pharmacies are critical to the provision of4
78	73		health-care services for Colorado's rural communities and vulnerable5
79	74		populations;6
80	75		(b) Nationally, one in 3 pharmacies have closed in the last decade;7
81	76		(c) A 2024 study of pharmacy closures found that 41% of the8
82	77		state's pharmacy closures were independent pharmacies, with the majority9
83	78		of those closures located in rural areas of the state;10
84	79		(d) Rural independent pharmacies have higher rates of permanent11
85	80		closure and report low reimbursement rates from pharmacy benefit12
86	81		managers, or "PBMs", as the key contributing factor;13
87	82		1222-2- (e) Nationally, PBMs are under scrutiny for restricting consumer1
88	83		choice, steering patients to select pharmacies, and reimbursing rural2
89	84		independent pharmacies below cost;3
90	85		4
91	86		(f) Rural independent pharmacies offer a wide variety of5
92	87		health-care services, ranging from prescription drug delivery; special drug6
93	88		packaging for vulnerable populations; medication management; wellness7
94	89		and prevention services; immunizations; chronic and acute care8
95	90		management; testing and treatment for strep throat, flu, and COVID-19;9
96	91		blood pressure and glucose screenings; and diabetes education and10
97	92		management, and provide health-care services for hospitals, long-term11
98	93		care facilities, and health clinics; and12
99	94		(g) When rural independent pharmacies close, patients lose access13
100	95		to care, communities lose health-care providers, and Coloradans are14
101	96		forced to travel greater distances to access care or are left completely15
102	97		without care.16
103	98		(2) Therefore, the general assembly declares that Colorado must17
104	99		preserve access to rural independent pharmacies for the state's rural18
105	100		communities and its most vulnerable populations.19
106	101		SECTION 2. In Colorado Revised Statutes, 10-16-102, add20
107	102		(59.5) as follows:21
108	103		10-16-102. Definitions. As used in this article 16, unless the22
109	104		context otherwise requires:23
110	105		(59.5) "R
111	106		URAL INDEPENDENT PHARMACY " MEANS A PRESCRIPTION24
112	107		DRUG OUTLET THAT IS PRIVATELY OWNED BY AT LEAST ONE LICENSED25
113	108		PHARMACIST WITH NO OWNERSHIP INTEREST BY OR AFFILIATION WITH A26
114	109		CHAIN PHARMACY OR A PUBLICLY TRADED PRESCRIPTION DRUG OUTLET .27
115	110		1222
116	111		-3- SECTION 3. In Colorado Revised Statutes, 10-16-122.1, amend1
117	112		(3) introductory portion; and add (3)(d) as follows:2
118	113		10-16-122.1. Contracts between PBMs and pharmacies -3
119	114		carrier submit list of PBMs - PBM registration - fees - prohibited4
120	115		practices - exception - rules - enforcement - short title - definitions.5
121	116		(3) Starting in 2022, A PBM or the representative of a PBM shall not:6
122	117		(d) (I) P
123	118		ROHIBIT A RURAL INDEPENDENT PHARMACY FROM USING7
124	119		A PRIVATE COURIER OR A DELIVERY SERVICE TO DELIVER A PRESCRIPTION8
125	120		DRUG TO A PATIENT; OR9
126	121		(II) R
127	122		EQUIRE A RURAL INDEPENDENT PHARMACY TO OBTAIN10
128	123		CONSENT FROM THE PBM TO USE A PRIVATE COURIER OR DELIVERY11
129	124		SERVICE TO DELIVER A PRESCRIPTION DRUG TO A PATIENT .12
130	125		SECTION 4. In Colorado Revised Statutes, 10-16-122.3, add13
131	126		(1.5) and (6)(b.3) as follows:14
132	127		10-16-122.3. Pharmacy benefit management firm payments -15
133	128		retroactive reduction prohibited - enforcement - rules - dispensing16
134	129		fees - definitions. (1.5) ON AND AFTER JANUARY 1, 2026, A PHARMACY17
135	130		BENEFIT MANAGEMENT FIRM SHALL REIMBURSE A RURAL INDEPENDENT18
136	131		PHARMACY FOR A PRESCRIPTION DRUG IN AN AMOUNT NOT LESS THAN THE19
137	132		NATIONAL AVERAGE DRUG ACQUISITION COST FOR THE DISPENSED20
138	133		PRESCRIPTION DRUG INGREDIENTS AND A DISPENSING FEE. IF THE21
139	134		NATIONAL AVERAGE DRUG ACQUISITION COST IS NOT AVAILABLE AT THE22
140	135		TIME A PRESCRIPTION DRUG IS ADMINISTERED OR DISPENSED, A PHARMACY23
141	136		BENEFIT MANAGEMENT FIRM SHALL NOT REIMBURSE IN AN AMOUNT THAT24
142	137		IS LESS THAN THE WHOLESALE ACQUISITION COST OF THE PRESCRIPTION25
143	138		DRUG. 26
144	139		(6) As used in this section:27
145	140		1222
146	141		-4- 1
147	142		(b.3) "DISPENSING FEE" MEANS THE REIMBURSEMENT AMOUNT2
148	143		FOR COSTS ASSOCIATED WITH FILLING A PRESCRIPTION, AS PUBLISHED FOR3
149	144		RURAL PHARMACIES IN 10 CCR 2505-10 SEC. 8.800.13.M, AS SPECIFIED IN4
150	145		THE VERSION OF THE RULE ADOPTED ON JULY 12, 2024. ON JANUARY 1,5
151	146		2027, AND ON JANUARY 1 OF EVERY YEAR THEREAFTER, A PHARMACY6
152	147		BENEFIT MANAGEMENT FIRM SHALL INCREASE THE AMOUNT OF THE7
153	148		DISPENSING FEE BY ONE PERCENT TO ACCOUNT FOR INFLATION . 8
154	149		SECTION 5. In Colorado Revised Statutes, 10-16-122.5, amend9
155	150		(1)(e) and (1)(f); and add (1)(g) as follows:10
156	151		10-16-122.5. Pharmacy benefit manager - audit of pharmacies11
157	152		- time limits on on-site audits - enforcement - rules. (1) A pharmacy12
158	153		benefit manager, a carrier, or an entity acting on behalf of a pharmacy13
159	154		benefit manager or a carrier that audits a pharmacy shall:14
160	155		(e) Establish a written appeals process that includes procedures to15
161	156		allow a pharmacy to appeal to the pharmacy benefit manager or the16
162	157		carrier the preliminary reports resulting from the audit and any resulting17
163	158		recoupment or penalty; and18
164	159		(f) Not subject a pharmacy to the recoupment of funds when an19
165	160		audit results in the identification of a clerical error in a required document20
166	161		or record unless the error results in actual financial harm to the pharmacy21
167	162		benefit manager, a health benefit plan providing prescription drug22
168	163		benefits that are managed by the pharmacy benefit manager, or a23
169	164		consumer;
170	165		AND24
171	166		(g) WHEN SUBJECTING A RURAL INDEPENDENT PHARMACY TO25
172	167		A RECOUPMENT OF FUNDS OF MORE THAN ONE THOUSAND DOLLARS OR A26
173	168		PENALTY OF MORE THAN ONE THOUSAND DOLLARS AS THE RESULT OF AN27
174	169		1222
175	170		-5- AUDIT:1
176	171		(I) ELECTRONICALLY NOTIFY THE RURAL INDEPENDENT PHARMACY2
177	172		OF THE RURAL INDEPENDENT PHARMACY 'S RIGHTS TO APPEAL PURSUANT3
178	173		TO SUBSECTION (1)(e) OF THIS SECTION AT LEAST THIRTY DAYS BEFORE4
179	174		THE RECOUPMENT OF FUNDS ;5
180	175		(II) IF THE RURAL INDEPENDENT PHARMACY DOES NOT RESPOND6
181	176		TO THE ELECTRONIC NOTIFICATION PROVIDED PURSUANT TO SUBSECTION7
182	177		(1)(g)(I) OF THIS SECTION WITHIN THIRTY DAYS AFTER THE ELECTRONIC8
183	178		NOTIFICATION, AGAIN ELECTRONICALLY NOTIFY THE RURAL INDEPENDENT9
184	179		PHARMACY OF THE RURAL INDEPENDENT PHARMACY'S RIGHTS TO APPEAL10
185	180		PURSUANT TO SUBSECTION (1)(e) OF THIS SECTION AT LEAST THIRTY DAYS11
186	181		BEFORE THE RECOUPMENT OF FUNDS ; AND12
187	182		(III) IF THE RURAL INDEPENDENT PHARMACY DOES NOT RESPOND13
188	183		TO THE SECOND ELECTRONIC NOTIFICATION PROVIDED PURSUANT TO14
189	184		SUBSECTION (1)(g)(II) OF THIS SECTION WITHIN THIRTY DAYS AFTER THE15
190	185		SECOND ELECTRONIC NOTIFICATION, SERVE PROCESS ON THE RURAL16
191	186		INDEPENDENT PHARMACY NOTIFYING OF THE RURAL INDEPENDENT17
192	187		PHARMACY'S RIGHTS TO APPEAL PURSUANT TO SUBSECTION (1)(e) OF THIS18
193	188		SECTION AT LEAST THIRTY DAYS BEFORE THE RECOUPMENT OF FUNDS .19
194	189		SECTION 6. In Colorado Revised Statutes, 12-280-103, add 20
195	190		(46.7) as follows:21
196	191		12-280-103. Definitions - rules. As used in this article 280, unless22
197	192		the context otherwise requires or the term is otherwise defined in another23
198	193		part of this article 280:24
199	194		25
200	195		(46.7) "R
201	196		URAL INDEPENDENT PHARMACY " HAS THE MEANING SET26
202	197		FORTH IN SECTION 10-16-102 (59.5).27
203	198		1222
204	199		-6- SECTION 7. In Colorado Revised Statutes, 12-280-118, add1
205	200		(3)(d) as follows:2
206	201		12-280-118. Prescription drug outlet under charge of3
207	202		pharmacist - rules.(3) (d) A PRESCRIPTION DRUG OUTLET THAT IS A4
208	203		RURAL INDEPENDENT PHARMACY NEED NOT BE UNDER THE DIRECT5
209	204		CHARGE OF A PHARMACIST IF THE INITIAL INTERPRETATION AND FINAL6
210	205		EVALUATION OF THE PRESCRIPTION IS DONE BY A STATE-LICENSED7
211	206		PHARMACIST IN PERSON OR REMOTELY . 8
212	207		SECTION 8. Act subject to petition - effective date -9
213	208		applicability. (1) Section 10-16-122.3, Colorado Revised Statutes, as10
214	209		amended in section 4 of this act, takes effect January 1, 2026, and the11
215	210		remainder of the act takes effect at 12:01 a.m. on the day following the12
216	211		expiration of the ninety-day period after final adjournment of the general13
217	212		assembly; except that, if a referendum petition is filed pursuant to section14
218	213		1 (3) of article V of the state constitution against this act or an item,15
219	214		section, or part of this act within such period, then the act, item, section,16
220	215		or part will not take effect unless approved by the people at the general17
221	216		election to be held in November 2026 and, in such case, will take effect18
222	217		on the date of the official declaration of the vote thereon by the governor.19
223	218		(2) This act applies to conduct occurring on or after the applicable20
224	219		effective date of this act.21
225	220		1222
226	221		-7-