HB 22-1122
signedPharmacy Benefit Manager Prohibited Practices
Plain-English Summary
AI-generatedHouse Bill 22-1122, also known as the "Colorado 340B Prescription Drug Program Anti-discrimination Act," stops health insurance companies and pharmacy benefit managers from treating pharmacies that participate in a federal program called 340B unfairly. This means these organizations can't pay less to or charge more for medications from these special pharmacies compared to other regular pharmacies, nor can they restrict access to their networks or impose extra fees on them. The bill is now signed into law, meaning it's officially active and being enforced in Colorado.
Official Summary
The act 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 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 act 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;
Restricting the methods by which a 340B covered entity or contract pharmacy may dispense or deliver 340B drugs; or
Requiring a claim for a 340B drug to include a modifier or other method of identifying the claim for a 340B drug.
A violation of the act is an unfair or deceptive act or practice in the business of insurance. The act authorizes the commissioner of insurance to adopt rules to implement the act.
The act 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 act.
(Note: This summary applies to this bill as enacted.)
Details
- Chamber
- House
- First action
- 2022-06-02
- Latest action
- 2022-01-21
- Last action desc.
- Introduced In House - Assigned to Health & Insurance
- OpenStates
- View source ↗
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Votes
REPASS
2022-05-10 · House · pass — Yes: 43 · No: 22 · Other: —
CONCUR
2022-05-10 · House · pass — Yes: 45 · No: 20 · Other: —
BILL
2022-05-09 · Senate · pass — Yes: 24 · No: 11 · Other: —
BILL
2022-04-22 · House · pass — Yes: 44 · No: 20 · Other: —