First Regular Session
Seventy-fifth General Assembly
STATE OF COLORADO
REVISED
This Version Includes All Amendments Adopted
on Second Reading in the Second House
LLS NO. 25-0494.01 Josh Schultz x5486
HOUSE BILL 25-1222
House Committees Senate Committees
Health & Human Services 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
SENATE
Amended 2nd Reading
April 22, 2025
HOUSE
Amended 2nd Reading
March 20, 2025
HOUSE
3rd Reading Unamended
March 25, 2025
HOUSE SPONSORSHIP
Winter T. and Lukens, Armagost, Boesenecker, Johnson, Mauro, Zokaie, Bacon, Barron,
Bird, Bradley, Brown, Caldwell, Clifford, Duran, Espenoza, Froelich, Garcia Sander,
Gonzalez R., Hamrick, Joseph, Keltie, Mabrey, Marshall, Martinez, McCluskie, McCormick,
Paschal, Richardson, Rutinel, Soper, Stewart K., Story, Velasco, Weinberg
SENATE SPONSORSHIP
Roberts and Simpson, Baisley, Bright, Catlin, Hinrichsen, 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
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
4
(f) Rural independent pharmacies offer a wide variety of5
health-care services, ranging from prescription drug delivery; special drug6
packaging for vulnerable populations; medication management; wellness7
and prevention services; immunizations; chronic and acute care8
management; testing and treatment for strep throat, flu, and COVID-19;9
blood pressure and glucose screenings; and diabetes education and10
management, and provide health-care services for hospitals, long-term11
care facilities, and health clinics; and12
(g) When rural independent pharmacies close, patients lose access13
to care, communities lose health-care providers, and Coloradans are14
forced to travel greater distances to access care or are left completely15
without care.16
(2) Therefore, the general assembly declares that Colorado must17
preserve access to rural independent pharmacies for the state's rural18
communities and its most vulnerable populations.19
SECTION 2. In Colorado Revised Statutes, 10-16-102, add20
(59.5) as follows:21
10-16-102. Definitions. As used in this article 16, unless the22
context otherwise requires:23
(59.5) "R
URAL INDEPENDENT PHARMACY " MEANS A PRESCRIPTION24
DRUG OUTLET THAT IS PRIVATELY OWNED BY AT LEAST ONE LICENSED25
PHARMACIST WITH NO OWNERSHIP INTEREST BY OR AFFILIATION WITH A26
CHAIN PHARMACY OR A PUBLICLY TRADED PRESCRIPTION DRUG OUTLET .27
1222
-3- SECTION 3. In Colorado Revised Statutes, 10-16-122.1, amend1
(3) introductory portion; and add (3)(d) as follows:2
10-16-122.1. Contracts between PBMs and pharmacies -3
carrier submit list of PBMs - PBM registration - fees - prohibited4
practices - exception - rules - enforcement - short title - definitions.5
(3) Starting in 2022, A PBM or the representative of a PBM shall not:6
(d) (I) P
ROHIBIT A RURAL INDEPENDENT PHARMACY FROM USING7
A PRIVATE COURIER OR A DELIVERY SERVICE TO DELIVER A PRESCRIPTION8
DRUG TO A PATIENT; OR9
(II) R
EQUIRE A RURAL INDEPENDENT PHARMACY TO OBTAIN10
CONSENT FROM THE PBM TO USE A PRIVATE COURIER OR DELIVERY11
SERVICE TO DELIVER A PRESCRIPTION DRUG TO A PATIENT .12
SECTION 4. In Colorado Revised Statutes, 10-16-122.3, add13
(1.5) and (6)(b.3) as follows:14
10-16-122.3. Pharmacy benefit management firm payments -15
retroactive reduction prohibited - enforcement - rules - dispensing16
fees - definitions. (1.5) ON AND AFTER JANUARY 1, 2026, A PHARMACY17
BENEFIT MANAGEMENT FIRM SHALL REIMBURSE A RURAL INDEPENDENT18
PHARMACY FOR A PRESCRIPTION DRUG IN AN AMOUNT NOT LESS THAN THE19
NATIONAL AVERAGE DRUG ACQUISITION COST FOR THE DISPENSED20
PRESCRIPTION DRUG INGREDIENTS AND A DISPENSING FEE. IF THE21
NATIONAL AVERAGE DRUG ACQUISITION COST IS NOT AVAILABLE AT THE22
TIME A PRESCRIPTION DRUG IS ADMINISTERED OR DISPENSED, A PHARMACY23
BENEFIT MANAGEMENT FIRM SHALL NOT REIMBURSE IN AN AMOUNT THAT24
IS LESS THAN THE WHOLESALE ACQUISITION COST OF THE PRESCRIPTION25
DRUG. 26
(6) As used in this section:27
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(b.3) "DISPENSING FEE" MEANS THE REIMBURSEMENT AMOUNT2
FOR COSTS ASSOCIATED WITH FILLING A PRESCRIPTION, AS PUBLISHED FOR3
RURAL PHARMACIES IN 10 CCR 2505-10 SEC. 8.800.13.M, AS SPECIFIED IN4
THE VERSION OF THE RULE ADOPTED ON JULY 12, 2024. ON JANUARY 1,5
2027, AND ON JANUARY 1 OF EVERY YEAR THEREAFTER, A PHARMACY6
BENEFIT MANAGEMENT FIRM SHALL INCREASE THE AMOUNT OF THE7
DISPENSING FEE BY ONE PERCENT TO ACCOUNT FOR INFLATION . 8
SECTION 5. In Colorado Revised Statutes, 10-16-122.5, amend9
(1)(e) and (1)(f); and add (1)(g) as follows:10
10-16-122.5. Pharmacy benefit manager - audit of pharmacies11
- time limits on on-site audits - enforcement - rules. (1) A pharmacy12
benefit manager, a carrier, or an entity acting on behalf of a pharmacy13
benefit manager or a carrier that audits a pharmacy shall:14
(e) Establish a written appeals process that includes procedures to15
allow a pharmacy to appeal to the pharmacy benefit manager or the16
carrier the preliminary reports resulting from the audit and any resulting17
recoupment or penalty; and18
(f) Not subject a pharmacy to the recoupment of funds when an19
audit results in the identification of a clerical error in a required document20
or record unless the error results in actual financial harm to the pharmacy21
benefit manager, a health benefit plan providing prescription drug22
benefits that are managed by the pharmacy benefit manager, or a23
consumer;
AND24
(g) WHEN SUBJECTING A RURAL INDEPENDENT PHARMACY TO25
A RECOUPMENT OF FUNDS OF MORE THAN ONE THOUSAND DOLLARS OR A26
PENALTY OF MORE THAN ONE THOUSAND DOLLARS AS THE RESULT OF AN27
1222
-5- AUDIT:1
(I) ELECTRONICALLY NOTIFY THE RURAL INDEPENDENT PHARMACY2
OF THE RURAL INDEPENDENT PHARMACY 'S RIGHTS TO APPEAL PURSUANT3
TO SUBSECTION (1)(e) OF THIS SECTION AT LEAST THIRTY DAYS BEFORE4
THE RECOUPMENT OF FUNDS ;5
(II) IF THE RURAL INDEPENDENT PHARMACY DOES NOT RESPOND6
TO THE ELECTRONIC NOTIFICATION PROVIDED PURSUANT TO SUBSECTION7
(1)(g)(I) OF THIS SECTION WITHIN THIRTY DAYS AFTER THE ELECTRONIC8
NOTIFICATION, AGAIN ELECTRONICALLY NOTIFY THE RURAL INDEPENDENT9
PHARMACY OF THE RURAL INDEPENDENT PHARMACY'S RIGHTS TO APPEAL10
PURSUANT TO SUBSECTION (1)(e) OF THIS SECTION AT LEAST THIRTY DAYS11
BEFORE THE RECOUPMENT OF FUNDS ; AND12
(III) IF THE RURAL INDEPENDENT PHARMACY DOES NOT RESPOND13
TO THE SECOND ELECTRONIC NOTIFICATION PROVIDED PURSUANT TO14
SUBSECTION (1)(g)(II) OF THIS SECTION WITHIN THIRTY DAYS AFTER THE15
SECOND ELECTRONIC NOTIFICATION, SERVE PROCESS ON THE RURAL16
INDEPENDENT PHARMACY NOTIFYING OF THE RURAL INDEPENDENT17
PHARMACY'S RIGHTS TO APPEAL PURSUANT TO SUBSECTION (1)(e) OF THIS18
SECTION AT LEAST THIRTY DAYS BEFORE THE RECOUPMENT OF FUNDS .19
SECTION 6. In Colorado Revised Statutes, 12-280-103, add 20
(46.7) as follows:21
12-280-103. Definitions - rules. As used in this article 280, unless22
the context otherwise requires or the term is otherwise defined in another23
part of this article 280:24
25
(46.7) "R
URAL INDEPENDENT PHARMACY " HAS THE MEANING SET26
FORTH IN SECTION 10-16-102 (59.5).27
1222
-6- SECTION 7. In Colorado Revised Statutes, 12-280-118, add1
(3)(d) as follows:2
12-280-118. Prescription drug outlet under charge of3
pharmacist - rules.(3) (d) A PRESCRIPTION DRUG OUTLET THAT IS A4
RURAL INDEPENDENT PHARMACY NEED NOT BE UNDER THE DIRECT5
CHARGE OF A PHARMACIST IF THE INITIAL INTERPRETATION AND FINAL6
EVALUATION OF THE PRESCRIPTION IS DONE BY A STATE-LICENSED7
PHARMACIST IN PERSON OR REMOTELY . 8
SECTION 8. Act subject to petition - effective date -9
applicability. (1) Section 10-16-122.3, Colorado Revised Statutes, as10
amended in section 4 of this act, takes effect January 1, 2026, and the11
remainder of the act takes effect at 12:01 a.m. on the day following the12
expiration of the ninety-day period after final adjournment of the general13
assembly; except that, if a referendum petition is filed pursuant to section14
1 (3) of article V of the state constitution against this act or an item,15
section, or part of this act within such period, then the act, item, section,16
or part will not take effect unless approved by the people at the general17
election to be held in November 2026 and, in such case, will take effect18
on the date of the official declaration of the vote thereon by the governor.19
(2) This act applies to conduct occurring on or after the applicable20
effective date of this act.21
1222
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