Facing a $850M budget deficit, Gov. Jaris Polis (D) proposed cuts to the Medicaid professional dispensing fee (PDF) for pharmacies. For fiscal year 2025-2026, the Health Care Financing and Policy (HCFP) will cut the tiered fee by $85,000 and propose a $506,000 reduction for 2026-2027. Reimbursements for high-volume pharmacies will drop from $10.25 to $9.93 and from $9.31 to $8.72. 

Also in Colorado, a Rural Health Transformation Program Webinar for all stakeholders will be held from 10:00 am – 11:30 am Mountain Time on December 2. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Public Health Environment issued a Public Health Order and Standing Order today to address COVID-19 vaccine administration. These orders enable all vaccine providers to administer these vaccines in accordance with the Standing Order, eliminating the need for additional prescriptions. In addition to the Public Health Order and Standing Order, the Colorado State Board of Pharmacy will engage in emergency rulemaking on Friday, September 5, to adopt changes to Rule 3 and 19 to allow for continuity of vaccinations, especially COVID, thus ensuring that pharmacists, pharmacy interns, and pharmacy technicians may continue to prescribe, dispense and administer vaccinations in accordance with applicable Colorado Revised Statutes.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Prescription Drug Affordability Board (PDAB) is seeking comments on its proposal to cap payment for the drug Enbrel at the Medicare price. Enbrel is one of the first Medicare Part D 10 drugs to be included in the Medicare Drug Price Negotiation Program (MDPNP) beginning January 1, 2026. Rulemaking for Enbrel began in May, and the rulemaking hearings continued on upper payment limit (UPL) for Enbrel in July and August. The fourth and possibly final rulemaking hearing on UPL for Enbrel will be on October 3.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Gov. Jared Polis (D) issued an executive order announcing a special legislative session on August 21 to address a $1.2 billion budget shortfall caused by the passage of H.R. 1, the federal “One Big Beautiful Bill Act”. In addition to addressing fiscal issues, the Governor wants legislators to address health care, food insecurity and artificial intelligence issues.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health Care Policy & Financing l(HCPF) is hosting its annual virtual Stakeholder Webinar on August 12 from 9:00 am to 11:00am MT. Leaders will discuss emerging federal threats to Medicaid, state budget challenges, Medicaid cost trend drivers and HCPF's priorities for fiscal year 2025-2026.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health Care Policy and Financing (HCPF) is soliciting stakeholder input before August 30, regarding the draft Supervision Policy for Medicaid Billable Behavioral Health Services. Feedback can be provided either by attending a stakeholder meeting or providing written feedback using this Google Form.  

Also in Colorado, the Department of Regulatory Agencies (DORA) Board of Pharmacy is hosting a pharmacy stakeholder meeting on proposed rules on July 31 at 9:00 am MDT. Oral comments will be taken from webinar participants. Written comments need to be submitted as soon as possible so that they can be included in this stakeholder meeting.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Gov. Jared Polis (D) signed SB25-289, a law creating a new Drug Donation Program to facilitate the safe donation and dispensing of unused medicine to Coloradans in need. The program expands upon the drug donation provisions and the corresponding rules and regulations for the Board of Pharmacy; it establishes parameters for participation and sets directives for donation recipients on the requirements for record retention in the program; outlines how to distribute donated medicine; and identifies what types of medicine can be distributed through the donation program.  

Also in Colorado, the Health Care Policy & Financing (HCPF) annual Pharmacy Stakeholder Webinar is on August 12 from 9:00 am-11:00 am MT. Discussion will focus on emerging federal threats to Medicaid, state budget challenges, Medicaid cost trend drivers and priorities for fiscal year 2025-2026. Participants are encouraged to register for the webinar in advance.  

Finally in Colorado, SB25-308 creates a cash fund for state dollars designated to 1115 waiver programs such as health related social needs and re-entry services for those leaving prison or jail after incarceration.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Gov. Jared Polis (D) signed into law HB25-1222, a rate floor and telepharmacy bill that applies to independent pharmacies only, defined as "a drug outlet that is privately owned by at least one licensed pharmacist with no ownership interest by or affiliation with a chain pharmacy or a publicly traded prescription drug outlet." The law will reimburse independents no less than NADAC, plus a dispensing fee. It also includes audit protection provisions, and it exempts independent pharmacies from the direct supervision rule if the initial interpretation and final evaluation of the prescription are done by a pharmacist in person or remotely. 

Also in Colorado, the Governor also signed HB25-1094 allowing a PBM to earn income derived from a flat-dollar service fee assessment and prohibits a PBM from earning income based on the cost of a prescription drug; prohibiting a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic; requiring a PBM to credit income from a source other than a flat-dollar service fee to a health insurance carrier or a self-funded health benefit plan beneficiary; setting the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order or specialty pharmacy for a prescription drug; and requiring a PBM to make certain documents and data available to a carrier, a self-funded plan or the insurance commissioner upon request and authorizing the health benefit plan to execute an audit to validate compliance with the contract. 

Also in Colorado, the Governor signed SB25-301, law that streamlines prior authorization approvals for pharmacists. 

Finally in Colorado, the Governor signed SB25-071, the 340B bill. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Prior to the General Assembly adjourning on May 7, lawmakers passed several bills of interest to pharmacies, including:   

• HB25-1094, governing PBM practices – Allowing a PBM to earn income derived from a flat-dollar service fee assessment and prohibits a PBM from earning income based on the cost of a prescription drug; prohibiting a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic; requiring a PBM to credit income from a source other than a flat-dollar service fee to a health insurance carrier or a self-funded health benefit plan beneficiary; setting the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order or specialty pharmacy for a prescription drug; and requiring a PBM to make certain documents and data available to a carrier, a self-funded plan or the insurance commissioner upon request and authorizing the health benefit plan to execute an audit to validate compliance with the contract.

• HB25-1222, the bill's rate floor and telepharmacy provisions only apply to independent pharmacies, passed out of both houses on May 1. For the purposes of this bill, "rural independent pharmacies" are defined as a drug outlet that is privately owned by at least one licensed pharmacist with no ownership interest by or affiliation with a chain pharmacy or a publicly traded prescription drug outlet. The bill will reimburse independents not less than NADAC, plus pay a dispensing fee. It also includes audit protection provisions, and it exempts independent pharmacies from the direct supervision rule if the initial interpretation and final evaluation of the prescription are done by a pharmacist in person or remotely. 

Finally in Colorado, SB25-045, legislation that requires school of public health to analyze model legislation for implementing a single-payer, nonprofit, publicly financed, and privately delivered universal health-care payment system for Colorado that directly compensates a provider. A report detailing its findings must be submitted to the General Assembly by December 31, 2026. The bill creates the Statewide Health Care Analysis Collaborative under the Department of Health Care Policy and Financing (HCPF) to assist the university in its report. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.