Amendments for HB23-1201
House Journal, March 20
14 Amend printed bill, page 2, strike lines 2 through 20.
15
16 Strike pages 3 through 7.
17
18 Page 8, strike lines 1 through 6.
19
20 Renumber succeeding sections accordingly.
21
22 Page 8, line 20, after "2025," insert "AND EACH CALENDAR YEAR
23 THEREAFTER,".
24
25 Page 8, strike line 21 and substitute "SHALL DISCLOSE TO EACH
26 POLICYHOLDER OR THE POLICYHOLDER'S SPECIFICALLY DESIGNATED
27 BROKER OR CONSULTANT THE".
28
29 Page 8, line 26, after "DISCLOSURES" insert "REQUIRED".
30
31 Page 9, strike lines 20 and 21 and substitute:
32
33 "(VI) THE AVERAGE REBATE ACROSS ALL PAID PRESCRIPTIONS FOR
34 THE RESPECTIVE GROUP HEALTH BENEFIT PLAN AND THE AVERAGE REBATE
35 ACROSS ALL PAID PRESCRIPTIONS THAT PAY A REBATE FOR THE
36 RESPECTIVE GROUP HEALTH BENEFIT PLAN; AND".
37
38 Page 9, line 25, after "2025," insert "AND EACH CALENDAR YEAR
39 THEREAFTER,".
40
41 Page 10, line 1, strike "2025".
42
43 Page 10, strike lines 2 and 3 and substitute "WERE IN EFFECT THE
44 PREVIOUS CALENDAR YEAR, ANNUALIZING THE PREVIOUS YEAR'S ACTUAL
45 DATA FOR EACH RESPECTIVE CERTIFICATE".
46
47 Page 10, line 15, strike "CALENDAR YEAR 2025".
48
49 Page 10, after line 22 insert:
50
51 "(f) THE DISCLOSURES REQUIRED IN SUBSECTIONS (2)(b)(VI) AND
52 (2)(b)(VII) OF THIS SECTION MUST NOT DISCLOSE ANY PROPRIETARY
53 REBATE INFORMATION BETWEEN A DRUG MANUFACTURER AND THE
54 PHARMACY BENEFIT MANAGER OR ITS CARRIER AFFILIATE. THE
55 DISCLOSURE OF DATA REQUIRED BY THESE SUBSECTIONS MUST REPRESENT
1 THE AGGREGATE VALUE OF REBATES PASSING THROUGH FROM THE
2 PHARMACY BENEFIT MANAGER OR ITS CARRIER AFFILIATE TO THE HEALTH
3 BENEFIT PLAN AS DEFINED BY RULE OF THE COMMISSIONER.".
4
5 Page 10, strike lines 23 and 24 and substitute:
6
7 "(3) THE COMMISSIONER".
8
9 Page 11, line 1, strike "SECTION AND MAY, AS APPROPRIATE," and
10 substitute "SECTION.".
11
12 Page 11, strike lines 2 and 3.
13
14 Page 11, line 4, strike "FINANCING.".
15
16 Page 11, strike lines 5 and 6 and substitute "BY THE DIVISION,".
17
18 Page 11, line 7, strike "APPROPRIATE,".
19
20 Page 11, strike lines 20 through 22 and substitute "INFORMATION,
21 AVAILABLE ONLY TO THE COMMISSIONER AND THE COMMISSIONER'S
22 AUDITING DESIGNEE AND IS NOT SUBJECT TO".
23
24 Page 11, after line 27 insert:
25
26 "(6) (a) THE REQUIREMENTS OF SUBSECTIONS (1), (2), AND (4) OF
27 THIS SECTION APPLY TO AN EMPLOYER-SPONSORED HEALTH BENEFIT PLAN,
28 AN ASSOCIATED PHARMACY BENEFIT MANAGER, AND THE HEALTH BENEFIT
29 PLAN MEMBERS ONLY IF A PERSON, TAFT-HARTLEY TRUST, MUNICIPALITY,
30 STATE, LABOR UNION, PLAN SPONSOR, OR EMPLOYER THAT PROVIDES THE
31 EMPLOYER-SPONSORED HEALTH BENEFIT PLAN ELECTS TO BE SUBJECT TO
32 SUBSECTIONS (1), (2), AND (4) OF THIS SECTION FOR ITS MEMBERS THAT
33 RESIDE IN COLORADO.
34 (b) AS USED IN THIS SUBSECTION (6), "PHARMACY BENEFIT
35 MANAGER" MEANS AN ENTITY DOING BUSINESS IN THIS STATE THAT
36 ADMINISTERS OR MANAGES PRESCRIPTION DRUG BENEFITS, INCLUDING
37 CLAIMS PROCESSING SERVICES AND OTHER PRESCRIPTION DRUG OR DEVICE
38 SERVICES AS DEFINED IN SECTION 10-16-122.1, THAT IS IN A CONTRACTUAL
39 RELATIONSHIP DIRECTLY OR INDIRECTLY THROUGH AN AFFILIATE WITH AN
40 EMPLOYER-SPONSORED HEALTH BENEFIT PLAN, WHICH INCLUDES PLANS
41 THAT ARE SELF-INSURED OR REGULATED BY THE FEDERAL "EMPLOYEE
42 RETIREMENT INCOME SECURITY ACT OF 1974", 29 U.S.C. SEC. 1001 ET
43 SEQ., AS AMENDED, OFFERED BY:
44 (I) A PERSON;
45 (II) A TAFT-HARTLEY TRUST;
46 (III) A MUNICIPALITY;
47 (IV) THE STATE;
48 (V) A LABOR UNION;
49 (VI) A PLAN SPONSOR;
50 (VII) AN EMPLOYER; OR
51 (VIII) A COALITION OF EMPLOYERS OR AGGREGATION OF
52 EMPLOYERS WORKING TOGETHER TO NEGOTIATE IMPROVED CONTRACT
53 TERMS WITH A PHARMACY BENEFIT MANAGER.".
54
55 Renumber succeeding subsection accordingly.
1 Page 12, after line 13 insert:
2
3 "SECTION 2. In Colorado Revised Statutes, add 25.5-1-133 as
4 follows:
5 25.5-1-133. Prescription benefits - department and pharmacy
6 manager - contracts - audit - rules. (1) FOR CONTRACTS BETWEEN A
7 PHARMACY BENEFIT MANAGER AND THE STATE DEPARTMENT OR ONE OF
8 ITS AFFILIATED MANAGED CARE ORGANIZATIONS OFFERING A
9 PRESCRIPTION BENEFIT PLAN THAT IS ISSUED OR RENEWED ON OR AFTER
10 JANUARY 1, 2025, THE AMOUNT CHARGED BY THE PHARMACY BENEFIT
11 MANAGER TO THE STATE DEPARTMENT OR MANAGED CARE ORGANIZATION
12 FOR A PRESCRIPTION DRUG DISPENSED TO AN ENROLLEE IN THE PROGRAM
104 13 OF MEDICAL ASSISTANCE CREATED PURSUANT TO SECTION 25.5-4-
14 MUST BE EQUAL TO OR LESS THAN THE AMOUNT PAID BY THE PHARMACY
15 BENEFIT MANAGER TO A MEDICAID PHARMACY FOR THE PRESCRIPTION
16 DRUG DISPENSED TO THE ENROLLEE.
17 (2) THE STATE BOARD SHALL PROMULGATE RULES TO IMPLEMENT
18 THIS SECTION, INCLUDING RULES GUIDING AN AUDIT OF MANAGED CARE OR
19 FEE-FOR-SERVICE CLAIMS, TO ENSURE THAT THERE IS NO VIOLATION OF
20 SUBSECTION (1) OF THIS SECTION.".
21
22 Renumber succeeding section accordingly.