Prior to the end of Colorado’s legislative session sine die on May 8, Gov. Jared Polis (D) signed into law the following two PBM reform bills.
- HB23- 1201, limits the amount that health insurance carriers or pharmacy benefit managers (PBMs) may charge beneficiaries of select employer-sponsored plans for prescription drugs to no more than the amount paid by the plan or PBM to a contracted pharmacy. The bill applies to select contracts issued or renewed on or after January 1, 2025. The bill grants audit authority to the Department of Health Care Policy and Financing (HCPF) for Medicaid contractors and the Department of Regulatory Agencies (DORA) for all other contracts. Failure to comply is a deceptive trade practice in the business of insurance.
- HB23-1227 enhances enforcement authority over PBMs by the Commissioner of Insurance in the Division of Insurance (DOI), Department of Regulatory Agencies (DORA). It also requires all PBMs to register with the Commissioner and pay a registration fee. These fees, credited to the DOI Cash Fund, must fund the division’s costs to enforce PBM requirements and prohibitions.
For more information, contact NACDS’ Mary Staples at 817-442-1155.