For health coverage plans issued or renewed on or after January 1, 2024, the act requires a health insurance carrier (carrier) that provides coverage for prescription auto-injectors (injectors) to cap the total amount that a covered person is required to pay for injectors at an amount not to exceed $60 for a 2-pack of the injectors. The act allows coverage for injectors to be offered through a high deductible plan that qualifies for a health savings account, and a carrier may apply deductible amounts if the coverage is not considered by the United States department of the treasury to be preventive or to have an acceptable deductible amount.
Effective January 1, 2024, the act creates an epinephrine auto-injector affordability program (program) to provide low-cost injectors to eligible individuals. By January 1, 2024, each manufacturer must establish procedures and make injectors available as prescribed in the act to eligible individuals who hold a valid prescription for injectors.
The act establishes eligibility requirements that residents of Colorado must meet in order to be eligible for the program.
The act requires the division of insurance in the department of regulatory agencies (division) to create an application for the program for use by an individual seeking injectors through the program and requires the division and the department of health care policy and financing to make the application available on their websites and to promote the availability of the program.
A pharmacy that dispenses injectors is authorized to collect a copayment not to exceed $60 from the individual to cover the pharmacy's costs of processing and dispensing a 2-pack of injectors.
A manufacturer of injectors:
- Is required to make injectors available to individuals through the program;
- May be required to reimburse the dispensing pharmacy in an amount that the pharmacy paid for the number of injectors dispensed through the program or send the pharmacy a replacement supply of the same number of injectors;
- Is required to develop a process for a pharmacy to submit electronic reimbursement claims.
If a manufacturer fails to comply with the requirements of the act, the manufacturer engages in a deceptive trade practice and is subject to a $10,000 fine for each month of noncompliance.
The act appropriates $58,291 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the act.
APPROVED by Governor June 7, 2023
EFFECTIVE August 7, 2023
NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.
(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)