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HB22-1122

Pharmacy Benefit Manager Prohibited Practices

Concerning prohibiting certain practices by entities obligated to pay for prescription drug benefits, and, in connection therewith, making an appropriation.
Session:
2022 Regular Session
Subject:
Health Care & Health Insurance
Bill Summary

For contracts between a pharmacy benefit manager (PBM) and a pharmacy entered into or renewed on or after January 1, 2023, between a pharmacy benefit manager (PBM) and a pharmacy that is located in a county with a population of fewer than 100,000 people and that is owned by a licensed pharmacist, section 1 of the bill prohibits the PBM or its representative from reimbursing a pharmacy for a prescription drug in an amount less than the national average drug acquisition cost for the prescription drug.Section 2 enacts the "Colorado 340B Prescription Drug Program Anti-discrimination Act" (act), which prohibits health insurers, PBMs, and other third-party payers (third-party payers) from discriminating against entities including pharmacies, participating in the federal 340B drug pricing program (340B covered entity) , including a pharmacy that contracts with a 340B covered entity to provide dispensing services to the 340B entity (contract pharmacy) . Specifically, the bill prohibits a third-party payer from:

  • Refusing to reimburse a 340B covered entity or contract pharmacy for dispensing 340B drugs, imposing additional requirements or restrictions on 340B covered entities or contract pharmacies , or reimbursing a 340B covered entity or contract pharmacy for a 340B drug at a rate lower than the amount paid for the same drug to pharmacies that are not 340B covered entities or contract pharmacies ;
  • Assessing a fee, charge back, or other adjustment against a 340B covered entity or contract pharmacy , or restricting a 340B covered entity's or contract pharmacy's access to the third-party payer's pharmacy network, because the 340B covered entity or contract pharmacy participates in the 340B drug pricing program;
  • Requiring a 340B covered entity or contract pharmacy to contract with a specific pharmacy or health coverage plan in order to access the third-party payer's pharmacy network;
  • Imposing a restriction or an additional charge on a patient who obtains a prescription drug from a 340B covered entity or contract pharmacy ; or
  • Restricting the methods by which a 340B covered entity or contract pharmacy may dispense or deliver 340B drugs.

Section 2 makes Sections 2 and 3 make a violation of the act an unfair or deceptive act or practice in the business of insurance, and section 2 also authorizes the commissioner of insurance to adopt rules to implement the act.Section 4 appropriates $17,109 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the bill.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)


(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Status

Introduced
Passed

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