First Regular Session Seventy-fifth General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO. 25-0361.02 Brita Darling x2241 SENATE BILL 25-071 Senate Committees House Committees Health & Human Services A BILL FOR AN ACT C ONCERNING CERTAIN PRACTICES BY PERSONS PARTICIPATING IN THE101 SUPPLY CHAIN OF DRUGS PURCHASED UNDER THE FEDERAL 340B102 DRUG PRICING PROGRAM .103 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 .) Under the federal 340B drug pricing program (340B program), a covered entity, including certain hospitals, programs, and federally qualified health centers (covered entity), that serves patients with low income receives discounted outpatient drugs (340B drugs) from manufacturers that participate in the federal medicaid and medicare SENATE 3rd Reading Unamended March 26, 2025 SENATE Amended 2nd Reading March 25, 2025 SENATE SPONSORSHIP Michaelson Jenet and Rich, Hinrichsen, Amabile, Coleman, Exum, Frizell, Kolker, Liston, Marchman, Mullica, Pelton R., Roberts, Snyder HOUSE SPONSORSHIP Martinez and Taggart, 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. programs. Unless the receipt of 340B drugs is prohibited by the federal department of health and human services, the bill prohibits a manufacturer, wholesaler, third-party logistics provider, or repackager in this state, or an agent, contractor, or affiliate of those entities, including an entity that collects or processes health information, from directly or indirectly denying, restricting, prohibiting, discriminating against, or otherwise limiting the acquisition of a 340B drug by, or delivery of a 340B drug to, a covered entity, a pharmacy contracted with a covered entity, or a location otherwise authorized by a covered entity to receive and dispense 340B drugs. The bill also prohibits a manufacturer from directly or indirectly requiring a covered entity, a pharmacy contracted with a covered entity, or any other location authorized to receive 340B drugs by a covered entity to submit any health information, claims or utilization data, or other specified data that does not relate to a claim submitted to certain federal health care programs, unless the data is voluntarily furnished or required to be furnished under federal law. A violation of the prohibitions in the bill is an unfair or deceptive trade practice under the "Colorado Consumer Protection Act" (act), and the violator is subject to the enforcement provisions and penalties contained in that act. The attorney general may investigate and enforce the provisions of the bill, as well as a business harmed by a violation of the provisions of the bill. In addition, a person regulated by the state board of pharmacy (pharmacy board) that violates the provisions of the bill may be subject to discipline by the pharmacy board against the person's license, certification, or registration, as well as other penalties. The bill requires a covered entity that is a hospital to annually post on its public-facing website information concerning the annual, estimated, aggregate financial benefit to the hospital covered entity resulting from its ability to acquire pharmaceuticals at a discount through the 340B program and a description of how the hospital covered entity uses savings from participation in the 340B program. Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. In Colorado Revised Statutes, 6-1-105, add (1)(iiii)2 as follows:3 6-1-105. Unfair or deceptive trade practices - definitions.4 (1) A person engages in a deceptive trade practice when, in the course of5 the person's business, vocation, or occupation, the person:6 071-2- (iiii) VIOLATES ARTICLE 29 OF THIS TITLE 6.1 SECTION 2. In Colorado Revised Statutes, add article 29 to title2 6 as follows:3 ARTICLE 294 Colorado 340B Contract Pharmacy Protection Act5 6-29-101. Short title. T HE SHORT TITLE OF THIS ARTICLE 29 IS THE6 "C OLORADO 340B CONTRACT PHARMACY PROTECTION ACT".7 6-29-102. Legislative declaration. (1) T HE GENERAL ASSEMBLY8 FINDS AND DETERMINES THAT:9 (a) T HE 340B DRUG PRICING PROGRAM REQUIRES DRUG10 MANUFACTURERS TO PROVIDE DRUG DISCOUNTS ON IDENTIFIED11 OUTPATIENT DRUGS TO 340B COVERED ENTITIES AS A CONDITION OF12 MEDICAID AND MEDICARE PART B COVERING THOSE DRUGS;13 (b) C ONGRESS CREATED THE 340B PROGRAM IN 1992, STATING14 THAT THE PROGRAM'S BENEFITS "ENABLE [COVERED] ENTITIES TO STRETCH15 SCARCE FEDERAL RESOURCES AS FAR AS POSSIBLE , REACHING MORE16 ELIGIBLE PATIENTS AND PROVIDING MORE COMPREHENSIVE SERVICES ."17 (H.R. REP. NO.102-384 (II), AT 12 (1992)).18 (c) T HE 340B PROGRAM SUPPORTS COLORADO'S MEDICALLY19 VULNERABLE AND UNDERSERVED POPULATIONS BY PROVIDING20 ADDITIONAL RESOURCES TO 340B COVERED ENTITIES AND ALLOWING21 THESE ENTITIES TO DETERMINE THE MOST EFFECTIVE USE OF THESE22 RESOURCES;23 (d) T HE 340B PROGRAM IS A CRITICAL COMPONENT OF24 C OLORADO'S SAFETY NET INFRASTRUCTURE;25 (e) C OLORADO HAS SIXTY-EIGHT HOSPITALS STATEWIDE THAT26 PARTICIPATE IN THE 340B PROGRAM, WITH NEARLY NINETY PERCENT OF27 071 -3- THESE HOSPITALS OPERATING UNDER UNSUSTAINABLE LONG -TERM1 MARGINS;2 (f) A DDITIONALLY, COLORADO HAS TWENTY FEDERALLY3 QUALIFIED HEALTH CENTERS, OR FQHCS, ALL OF WHICH PARTICIPATE IN4 THE 340B PROGRAM AND SIXTY-FIVE PERCENT OF WHICH CURRENTLY5 OPERATE WITH NEGATIVE MARGINS ;6 (g) C OLORADO HOSPITALS PARTICIPATING IN THE 340B PROGRAM7 UTILIZE PROGRAM BENEFITS TO ADDRESS THEIR COMMUNITIES ' UNIQUE8 NEEDS, WHICH INCLUDE PROVIDING DIRECT PRESCRIPTION DRUG9 DISCOUNTS, SUBSIDIZING UNCOMPENSATED CHARITY CARE AND MEDICAID10 UNDERPAYMENTS TO REMAIN FINANCIALLY OPERATIONAL , SUPPORTING11 OPIOID USE DISORDER TREATMENT , FUNDING MOBILE HEALTH-CARE AND12 IMMUNIZATION CLINICS, AND PAYING FOR CHEMOTHERAPY AND INFUSION13 CENTERS;14 (h) C OLORADO'S FQHCS ARE THE PRIMARY CARE MEDICAL HOME15 FOR ONE IN SEVEN COLORADANS, WITH EIGHTY-NINE PERCENT OF FQHCS'16 PATIENTS IN 2023 LIVING WITH FAMILY INCOMES BELOW TWO HUNDRED17 PERCENT OF THE FEDERAL POVERTY GUIDELINE AND TWENTY -THREE18 PERCENT WERE UNINSURED ;19 (i) C OLORADO'S FQHCS UTILIZE 340B PROGRAM BENEFITS TO20 ADDRESS THEIR COMMUNITIES' UNIQUE NEEDS, WHICH INCLUDE REDUCED21 DRUG PRICES FOR PATIENTS, PROVIDER RECRUITMENT AND RETENTION ,22 AND EXPANSION OF ORAL HEALTH AND BEHAVIORAL HEALTH SERVICES23 THAT THE FQHCS WOULD OTHERWISE NOT BE ABLE TO OFFER ;24 (j) F URTHER, COLORADO'S FQHCS EXPERIENCED AN ESTIMATED25 LOSS OF FOUR MILLION THREE HUNDRED DOLLARS IN 340B PROGRAM26 SAVINGS IN THE LAST TWO YEARS;27 071 -4- (k) CONVERSELY, IN 2023, SIXTEEN OF THE LARGEST1 PHARMACEUTICAL COMPANIES REPORTED SIX HUNDRED EIGHTY -FOUR2 BILLION DOLLARS IN EARNINGS IN THEIR ANNUAL FINANCIAL REPORTS , A3 FIGURE THAT WAS HIGHER THAN THE GROSS DOMESTIC PR ODUCT OF4 EIGHTY-EIGHT PERCENT OF THE COUNTRIES IN THE WORLD ;5 (l) I N ADDITION, THE EIGHT LARGEST PHARMACEUTICAL6 COMPANIES PAID A COMBINED TWO BILLION DOLLARS IN FEDERAL TAXES7 ON TWO HUNDRED FOURTEEN BILLION DOLLARS OF DOMESTIC REVENUE IN8 2022, ACCORDING TO THEIR 10-K ANNUAL FINANCIAL REPORTS;9 (m) I N 2022, COLORADO HOSPITALS PROVIDED TWO BILLION ONE10 HUNDRED MILLION DOLLARS OF COMMUNITY BENEFIT ;11 (n) S TARTING IN 2020, PHARMACEUTICAL MANUFACTURERS BEGAN12 TO UNLAWFULLY PLACE RESTRICTIONS ON 340B COVERED ENTITIES USING13 CONTRACT PHARMACIES TO DISPENSE DRUGS TO PATIENTS , UNILATERALLY14 LIMITING THE 340B PROGRAM'S BENEFITS; AND15 (o) I N A LETTER DATED JULY 28, 2023, FROM WILLIAM TONG,16 ATTORNEY GENERAL OF CONNECTICUT, TO THE UNITED STATES SENATE17 340B WORKING GROUP, AND SIGNED BY TWENTY-TWO OTHER BIPARTISAN18 ATTORNEYS GENERAL , THE ATTORNEYS GENERAL DECLARED THAT19 " OUTPATIENT PHARMACIES ARE A KEY MECHANISM FOR THE DELIVERY OF20 LIFE-SAVING DRUGS TO ELIGIBLE PATIENTS, INCLUDING THOSE WHO HAVE21 LIMITED ACCESS TO TRANSPORTATION , LIVE IN REMOTE OR RURAL AREAS,22 OR ARE CONFINED TO THEIR HOMES AND RELY ON MAIL -ORDER23 PHARMACIES."24 (2) T HEREFORE, THE GENERAL ASSEMBLY DECLARES THAT THIS25 ARTICLE 29 PROHIBITING PHARMACEUTICAL MANUFACTURERS FROM26 IMPOSING LIMITATIONS OR PLACING RESTRICTIVE CONDITIONS ON 340B27 071 -5- COVERED ENTITIES IS NECESSARY TO PROTECT COLORADO'S VULNERABLE1 PATIENTS AND SAFETY NET PROVIDERS AND TO ENSURE THAT2 MUCH-NEEDED FINANCIAL RESOURCES GENERATED BY THE 340B PROGRAM3 REMAIN IN COLORADO FOR THE BENEFIT OF THE PUBLIC .4 6-29-103. Definitions. A S USED IN THIS ARTICLE 29, UNLESS THE5 CONTEXT OTHERWISE REQUIRES :6 (1) "340B COVERED ENTITY" OR "COVERED ENTITY" HAS THE7 MEANING SET FORTH IN SECTION 340B (a)(4) OF THE FEDERAL "PUBLIC8 H EALTH SERVICE ACT", 42 U.S.C. SEC. 256b (a)(4).9 (2) "340B DRUG" MEANS A DRUG THAT:10 (a) I S A COVERED OUTPATIENT DRUG WITHIN THE MEANING SET11 FORTH IN 42 U.S.C. SEC. 256b;12 (b) H AS BEEN SUBJECT TO ANY OFFER FOR REDUCED PRICES BY A13 MANUFACTURER PURSUANT TO 42 U.S.C. SEC. 256b (a)(1); AND14 (c) I S PURCHASED BY A COVERED ENTITY . AS USED IN THIS15 SUBSECTION (2)(c), A DRUG IS CONSIDERED "PURCHASED" IF IT WOULD16 HAVE BEEN PURCHASED BUT FOR THE RESTRICTION OR LIMITATION17 DESCRIBED IN SECTION 6-29-105.18 (3) "340B DRUG PRICING PROGRAM" OR "340B PROGRAM" MEANS19 THE PROGRAM DESCRIBED IN 42 U.S.C. SEC. 256b (a)(1).20 (4) "340B SAVINGS" MEANS THE DIFFERENCE BETWEEN THE 21 AGGREGATED MARKET RATE COSTS AND THE AGGREGATED ACQUISITION22 COSTS FOR 340B DRUGS.23 (5) "BOARD" MEANS THE STATE BOARD OF PHARMACY CREATED IN24 SECTION 12-280-104.25 (6) "FEDERAL HEALTH CARE PROGRAM " HAS THE MEANING SET26 FORTH IN SECTION 42 U.S.C. SEC. 1320a-7b (f).27 071 -6- (7) "HEALTH INFORMATION" MEANS INFORMATION, INCLUDING1 DEMOGRAPHIC INFORMATION COLLECTED FROM AN INDIVIDUAL OR A2 GROUP OF INDIVIDUALS THAT:3 (a) I S CREATED OR RECEIVED BY A HEALTH -CARE PROVIDER,4 PHARMACY, HEALTH BENEFIT PLAN , EMPLOYER, OR HEALTH-CARE5 CLEARINGHOUSE; AND6 (b) R ELATES TO THE PAST, PRESENT, OR FUTURE PHYSICAL OR7 MENTAL HEALTH OR CONDITION OF AN INDIVIDUAL , THE PROVISION OF8 HEALTH CARE TO AN INDIVIDUAL , OR THE PAST, PRESENT, OR FUTURE9 PAYMENT FOR THE PROVISION OF HEALTH CARE TO AN INDIVIDUAL .10 (8) "MANUFACTURER" HAS THE MEANING SET FORTH IN SECTION11 12-280-103 (27).12 (9) "PACKAGE" HAS THE MEANING SET FORTH IN 21 U.S.C. SEC.13 360eee (11)(A).14 (10) "PHARMACY" HAS THE MEANING SET FORTH IN SECTION15 12-280-103 (43).16 (11) "REPACKAGER" HAS THE MEANING SET FORTH IN SECTION17 12-280-103 (46).18 (12) "THIRD-PARTY LOGISTICS PROVIDER" HAS THE MEANING SET19 FORTH IN SECTION 12-280-103 (52.5).20 21 6-29-104. Applicability. T HIS ARTICLE 29 APPLIES TO A22 MANUFACTURER, THIRD-PARTY LOGISTICS PROVIDER, OR REPACKAGER23 OF A MANUFACTURER 'S DRUGS DOING BUSINESS IN THIS STATE AND24 ENGAGED IN THE PRODUCTION, MANUFACTURE, DISTRIBUTION, OR SALE OF25 A 340B DRUG IN THIS STATE.26 6-29-105. Acquisition of 340B drugs - prohibited acts - use of27 071 -7- savings - enforcement - penalties - nonpreemption - data exclusions.1 (1) Prohibited acts. O N AND AFTER THE EFFECTIVE DATE OF THIS2 ARTICLE 29:3 (a) U NLESS THE RECEIPT OF THE 340B DRUGS IS PROHIBITED BY4 THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES , A5 MANUFACTURER, THIRD-PARTY LOGISTICS PROVIDER, OR REPACKAGER,6 OR AN AGENT, CONTRACTOR, OR AFFILIATE OF A MANUFACTURER , 7 THIRD-PARTY LOGISTICS PROVIDER , OR REPACKAGER, INCLUDING AN8 ENTITY THAT COLLECTS OR PROCESSES HEALTH INFORMATION , SHALL NOT,9 DIRECTLY OR INDIRECTLY, DENY, RESTRICT, PROHIBIT, DISCRIMINATE10 AGAINST, OR OTHERWISE LIMIT THE ACQUISITION OF A 340B DRUG BY, OR11 DELIVERY OF A 340B DRUG TO, A 340B COVERED ENTITY, A PHARMACY12 CONTRACTED WITH A 340B COVERED ENTITY, OR A LOCATION OTHERWISE13 AUTHORIZED BY A 340B COVERED ENTITY TO RECEIVE AND DISPENSE 340B14 DRUGS; AND15 (b) A MANUFACTURER SHALL NOT DIRECTLY OR INDIRECTLY16 REQUIRE, INCLUDING AS A CONDITION , A 340B COVERED ENTITY, A17 PHARMACY CONTRACTED WITH A 340B COVERED ENTITY, OR ANY OTHER18 LOCATION AUTHORIZED TO RECEIVE 340B DRUGS BY A 340B COVERED19 ENTITY TO SUBMIT ANY HEALTH INFORMATION , CLAIMS OR UTILIZATION20 DATA, PURCHASING DATA, PAYMENT DATA, OR OTHER DATA THAT DOES21 NOT RELATE TO A CLAIM SUBMITTED TO A FEDERAL HEALTH CARE22 PROGRAM, UNLESS SUCH DATA IS VOLUNTARILY FURNISHED BY SUCH23 COVERED ENTITY OR OTHERWISE REQUIRED TO BE FURNISHED UNDER24 APPLICABLE FEDERAL LAW.25 (2) A COVERED ENTITY THAT IS A REPORTING HOSPITAL , AS 26 DEFINED IN SECTION 25.5-1-701, SHALL NOT USE 340B SAVINGS FOR THE27 071 -8- FOLLOWING PURPOSES:1 (a) M ORE THAN THIRTY-FIVE PERCENT OF TOTAL ANNUAL 2 COMPENSATION OR EXPENSE REIMBURSEMENT FOR THE HOSPITAL 'S BOARD3 OF DIRECTORS;4 (b) T AX PENALTIES OR FINES ISSUED AGAINST THE HOSPITAL ; 5 (c) E XPENSES RELATED TO ADVERTISING AND PUBLIC RELATIONS 6 THAT PROMOTE THE HOSPITAL 'S IMAGE, SERVICES, OR PROPOSALS, NOT7 INCLUDING COMMUNICATIONS REQUIRED BY LAW OR THAT ARE ESSENTIAL8 FOR PATIENT SAFETY AND PATIENT INFORMATION ;9 (d) L OBBYING EXPENSES AND OTHER COSTS INTENDED TO 10 INFLUENCE LEGISLATION OR BALLOT MEASURES AT THE LOCAL , STATE, OR11 FEDERAL LEVEL;12 (e) T RAVEL, LODGING, FOOD, OR BEVERAGE EXPENSES FOR THE 13 HOSPITAL'S BOARD OF DIRECTORS AND OFFICERS; AND14 (f) G IFTS OR ENTERTAINMENT EXPENSES . 15 (3) Enforcement - penalties. (a) T HE ATTORNEY GENERAL MAY16 INVESTIGATE A COMPLAINT CONCERNING A VIOLATION OF THIS ARTICLE17 29. A PERSON THAT VIOLATES THIS ARTICLE 29 RISKS THE PUBLIC'S 18 HEALTH AND ENGAGES IN AN UNFAIR OR DECEPTIVE TRADE PRACTICE19 PURSUANT TO SECTION 6-1-105 (1)(iiii) AND IS SUBJECT TO THE20 ENFORCEMENT PROVISIONS , CIVIL PENALTIES, AND DAMAGES SET FORTH21 IN ARTICLE 1 OF THIS TITLE 6.22 (b) E ACH PACKAGE OF A 340B DRUG THAT CONSTITUTES A23 PROHIBITED ACT UNDER THIS ARTICLE 29 CONSTITUTES A SEPARATE24 VIOLATION OF SUBSECTION (1) OF THIS SECTION.25 (c) L IMITED DISTRIBUTION OF A DRUG REQUIRED UNDER 21 U.S.C.26 SEC. 355-1 DOES NOT CONSTITUTE A VIOLATION OF THIS ARTICLE 29.27 071 -9- (d) A PERSON REGULATED BY THE STATE BOARD OF PHARMACY1 CREATED IN SECTION 12-280-104 MAY BE SUBJECT TO DISCIPLINE2 PURSUANT TO SECTION 12-280-108 (1)(c), (1)(d), OR (1)(i) FOR VIOLATING3 THIS ARTICLE 29.4 (4) Nonpreemption. N OTHING IN THIS ARTICLE 29 SHALL BE5 CONSTRUED OR APPLIED TO BE LESS RESTRICTIVE THAN ANY FEDERAL LAW6 APPLYING TO PERSONS REGULATED BY THIS SECTION . NOTHING IN THIS7 SECTION SHALL BE CONSTRUED OR APPLIED TO BE IN CONFLICT WITH ANY8 OF THE FOLLOWING:9 (a) A PPLICABLE FEDERAL LAW AND RELATED REGULATIONS ; OR10 (b) O THER LAWS OF THIS STATE, IF THE LAWS ARE COMPATIBLE11 WITH APPLICABLE FEDERAL LAW .12 (5) Data exclusions. S UBSECTION (1) OF THIS SECTION DOES NOT13 PROHIBIT A MANUFACTURER FROM REQUIRING HEALTH INFORMATION OR14 OTHER DATA THAT A COVERED ENTITY IS REQUIRED TO FURNISH TO THE15 MANUFACTURER UNDER APPLICABLE FEDERAL LAW , INCLUDING DATA16 RELATING TO AN AUDIT IN ACCORDANCE WITH PROCEDURES ESTABLISHED17 BY THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES UNDER18 42 U.S.C. SEC. 256b (a)(5)(C).19 SECTION 3. In Colorado Revised Statutes, add 25-3-132 as20 follows:21 25-3-132. 340B drug pricing program transparency -22 definitions. (1) A S USED IN THIS SECTION:23 (a) "340B DRUG PRICING PROGRAM" OR "340B PROGRAM" MEANS24 THE PROGRAM DESCRIBED IN 42 U.S.C. SEC. 256b (a)(1).25 (b) "340B SAVINGS" MEANS THE DIFFERENCE BETWEEN THE 26 AGGREGATED MARKET RATE COSTS AND THE AGGREGATED ACQUISITION27 071 -10- COSTS FOR 340B DRUGS.1 (c) "HOSPITAL COVERED ENTITY" MEANS A HOSPITAL LICENSED OR2 CERTIFIED BY THE DEPARTMENT PURSUANT TO THE DEPARTMENT 'S3 AUTHORITY UNDER SECTION 25-1.5-103 (1)(a) AND THAT IS A "COVERED4 ENTITY" AS DEFINED IN 42 U.S.C. SEC. 256b (a)(4).5 (2) E XCEPT AS PROVIDED IN SUBSECTION (3) OF THIS SECTION,6 EACH HOSPITAL COVERED ENTITY THAT IS A REPORTING HOSPITAL , AS 7 DEFINED IN SECTION 25.5-1-701, SHALL INCLUDE THE FOLLOWING8 INFORMATION IN THE ANNUAL REPORT SUBMITTED PURSUANT TO SECTION9 25.5-1-703 (3): 10 (a) T HE ANNUAL, REPORTED 340B SAVINGS TO THE HOSPITAL11 COVERED ENTITY RESULTING FROM ITS ABILITY TO ACQUIRE12 PHARMACEUTICALS AT A DISCOUNT THROUGH THE 340B DRUG PRICING13 PROGRAM;14 (b) A DESCRIPTION OF HOW THE HOSPITAL COVERED ENTITY USES15 SAVINGS FROM PARTICIPATION IN THE 340B PROGRAM; 16 (c) T HE AGGREGATED MARKET RATE COSTS AND THE AGGREGATED 17 ACQUISITION COSTS FOR 340B DRUGS USED TO CALCULATE 340B SAVINGS;18 AND19 (d) T HE TOTAL OPERATING COSTS OF THE HOSPITAL COVERED 20 ENTITY AND COSTS RELATING TO PROVIDING CHARITY CARE .21 (3) N OTHING IN THIS SECTION REQUIRES THE PUBLIC DISCLOSURE22 OF RECORDS THAT ARE PUBLIC RECORDS UNDER THE "COLORADO OPEN23 R ECORDS ACT", PART 2 OF ARTICLE 72 OF TITLE 24, BUT THAT ARE24 EXEMPTED FROM DISCLOSURE UNDER THAT ACT .25 SECTION 4. Severability. If any provision of this act or the26 application thereof to any person or circumstance is held invalid, such27 071 -11- invalidity does not affect other provisions or applications of the act that1 can be given effect without the invalid provision or application, and to2 this end the provisions of this act are declared to be severable.3 SECTION 5. Act subject to petition - effective date. This act4 takes effect at 12:01 a.m. on the day following the expiration of the5 ninety-day period after final adjournment of the general assembly; except6 that, if a referendum petition is filed pursuant to section 1 (3) of article V7 of the state constitution against this act or an item, section, or part of this8 act within such period, then the act, item, section, or part will not take9 effect unless approved by the people at the general election to be held in10 November 2026 and, in such case, will take effect on the date of the11 official declaration of the vote thereon by the governor.12 071 -12-