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Legislative Year: 2022 Change
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Bill Detail: HB22-1122

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Title Pharmacy Benefit Manager Prohibited Practices
Status House Considered Senate Amendments - Result was to Concur - Repass (05/10/2022)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors P. Will (R)
M. Lindsay (D)
Senate Sponsors S. Jaquez Lewis (D)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 01/21/2022
Summary

For contracts between a pharmacy benefit manager (PBM) and a
pharmacy entered into or renewed on or after January 1, 2023, 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). Specifically, the bill
prohibits a third-party payer from:

  • Refusing to reimburse a 340B covered entity for dispensing
340B drugs, imposing additional requirements or
restrictions on 340B covered entities, or reimbursing a
340B covered entity for a 340B drug at a rate lower than
the amount paid for the same drug to pharmacies that are
not 340B covered entities;
  • Assessing a fee, charge back, or other adjustment against
a 340B covered entity, or restricting a 340B covered
entity's access to the third-party payer's pharmacy network,
because the covered entity participates in the 340B drug
pricing program;
  • Requiring a 340B covered entity 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
  • Restricting the methods by which a 340B covered entity
may dispense or deliver 340B drugs.
Section 2 makes a violation of the act an unfair or deceptive act or
practice in the business of insurance and authorizes the commissioner of
insurance to adopt rules to implement the act.

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