Amendments for HB23-1227
House Journal, March 15
41 Amend printed bill, page 3, lines 2 and 3, strike "amend (2)(a); and".
42
43 Page 3, strike lines 7 through 21.
44
45 Page 7, line 5, strike "(2) AND".
House Journal, March 30
5 HB23-1227 be amended as follows, and as so amended, be referred to
6 the Committee of the Whole with favorable
7 recommendation:
8
9 Amend printed bill, page 7, after line 20 insert:
10
11 "SECTION 9. Appropriation. For the 2023-24 state fiscal year,
12 $206,647 is appropriated to the department of regulatory agencies for use
13 by the division of insurance. This appropriation is from the division of
14 insurance cash fund created in section 10-1-103 (3), C.R.S. To implement
15 this act, the division may use this appropriation as follows:
16 (a) $183,262 for personal services, which amount is based on an
17 assumption that the division will require an additional 2.5 FTE;
18 and
19 (b) $23,385 for operating expenses.".
20
21 Renumber succeeding section accordingly.
22
23 Page 1, line 102, strike "MANAGERS." and substitute "MANAGERS, AND,
24 IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.".
25
26
House Journal, April 12
50 Amend printed bill, page 4, line 15, strike "16 AND SECTION 25-37-103.5."
51 and substitute "16.".
52
53 Page 6, strike lines 14 through 17 and substitute:
54
55
1 "SECTION 7. In Colorado Revised Statutes, add with amended
2 and relocated provisions 10-16-122.6 as follows:
3 10-16-122.6. [Formerly 25-37-103.5] Pharmacy benefit
4 managers - contracts with pharmacies - maximum allowable cost
5 pricing - enforcement - rules. (1) (a) In each contract between a
6 pharmacy benefit manager and a pharmacy, the pharmacy shall be given
7 the right to obtain from the pharmacy benefit manager, within ten days
8 after any request, a current list of the sources used to determine maximum
9 allowable cost pricing. The pharmacy benefit manager shall update the
10 pricing information at least every seven days and provide a means by
11 which contracted pharmacies may promptly review pricing updates in a
12 format that is readily available and accessible.
13 (b) A pharmacy benefit manager shall maintain a procedure to
14 eliminate products from the list of drugs subject to maximum allowable
15 cost pricing in a timely manner in order to remain consistent with pricing
16 changes in the marketplace.
17 (2) In order to place a prescription drug on a maximum allowable
18 cost list, a pharmacy benefit manager shall ensure that:
19 (a) The drug is listed as "A" or "B" rated in the most recent
20 version of the United States food and drug administration's approved drug
21 products with therapeutic equivalence evaluations, also known as the
22 orange book, or has an "NR" or "NA" rating or similar rating by a
23 nationally recognized reference; and
24 (b) The drug is generally available for purchase by pharmacies in
25 this state from a national or regional wholesaler and is not obsolete.
26 (3) Each contract between a pharmacy benefit manager and a
27 pharmacy must include a process to appeal, investigate, and resolve
28 disputes regarding maximum allowable cost pricing that includes:
29 (a) A twenty-one-day limit on the right to appeal following the
30 initial claim;
31 (b) A requirement that the appeal be investigated and resolved
32 within twenty-one days after the appeal;
33 (c) A telephone number at which the pharmacy may contact the
34 pharmacy benefit manager to speak to a person responsible for processing
35 appeals;
36 (d) A requirement that a pharmacy benefit manager provide a
37 reason for any appeal denial and the identification of the national drug
38 code, AS DEFINED IN SECTION 10-16-122.9 (2)(f), of a drug that may be
39 purchased by the pharmacy at a price at or below the benchmark price as
40 determined by the pharmacy benefit manager; and
41 (e) A requirement that a pharmacy benefit manager make an
42 adjustment to a date no later than one day after the date of determination.
43 This requirement does not prohibit a pharmacy benefit manager from
44 retroactively adjusting a claim for the appealing pharmacy or for another
45 similarly situated pharmacy.
46 (4) THE".
47
48 Page 6, line 18, strike "OF INSURANCE".
49
50 Page 6, after line 21, insert:
51
52 "(5) THE COMMISSIONER MAY ADOPT RULES TO IMPLEMENT AND
53 ENFORCE THIS SECTION.".
54
55 Page 7, after line 20, insert:
56
1 "SECTION 9. Repeal of relocated provision in this act. In
2 Colorado Revised Statutes, repeal 25-37-103.5.".
3
4 Renumber succeeding section accordingly.
5
6 Amendment No. 4, by Representative Jodeh:
7
8 Amend printed bill, page 3, line 3, strike "(2.5) and (4.5)" and substitute
9 "(2.5), (4.5), and (4.7)".
10
11 Page 4, line 3, after "RULES." add "THIS REGISTRATION REQUIREMENT
12 APPLIES TO ALL PBMS DOING BUSINESS IN THIS STATE, INCLUDING A PBM
13 THAT ADMINISTERS OR MANAGES PRESCRIPTION DRUG BENEFITS,
14 INCLUDING CLAIMS PROCESSING SERVICES AND OTHER PRESCRIPTION DRUG
15 OR DEVICE SERVICES, ON BEHALF OF ANY SELF-FUNDED PLAN THAT
16 PROVIDES PRESCRIPTION DRUG BENEFITS TO RESIDENTS OF THIS STATE.".
17
18 Page 4, line 4, after "(b)" insert "(I)".
19
20 Page 4, after line 7 insert:
21
22 "(II) THE COMMISSIONER MAY DENY A REGISTRATION TO A PBM;
23 SUSPEND, REVOKE, OR REFUSE TO ISSUE, CONTINUE, OR RENEW THE
24 REGISTRATION OF A PBM; OR ISSUE A CEASE-AND-DESIST ORDER TO A
25 PBM IF, AFTER NOTICE TO THE PBM AND AFTER A HEARING HELD IN
26 ACCORDANCE WITH SECTIONS 24-4-104 AND 24-4-105, THE COMMISSIONER
27 FINDS THAT THE PBM, OR AN OFFICER, DIRECTOR, OR EMPLOYEE OF THE
28 PBM, HAS:
29 (A) MADE A MATERIAL MISSTATEMENT, MISREPRESENTATION, OR
30 OMISSION IN A REGISTRATION OR REGISTRATION RENEWAL APPLICATION;
31 (B) FRAUDULENTLY OR DECEPTIVELY OBTAINED OR ATTEMPTED
32 TO OBTAIN A REGISTRATION OR RENEWAL OF A REGISTRATION;
33 (C) IN CONNECTION WITH THE ADMINISTRATION OF PRESCRIPTION
34 DRUG BENEFITS MANAGEMENT SERVICES, COMMITTED FRAUD OR ENGAGED
35 IN ILLEGAL OR DISHONEST ACTIVITIES; OR
36 (D) VIOLATED ANY PROVISION OF THIS TITLE 10.
37 (III) A DETERMINATION OF THE COMMISSIONER IS A FINAL AGENCY
38 ACTION SUBJECT TO JUDICIAL REVIEW PURSUANT TO SECTION 24-4-106.".
39
40 Page 4, after line 19 insert:
41
42 "(4.7) THE COMMISSIONER MAY ADOPT RULES TO IMPLEMENT AND
43 ENFORCE THIS SECTION.".
44
45 Page 4, line 20, after "10-16-122.3," insert "amend (4); and".
46
47 Page 4, line 24, strike "(5.5)" and substitute "(4) The division may
48 promulgate rules TO IMPLEMENT AND ENFORCE THIS SECTION, INCLUDING
49 RULES to establish the manner in which carriers and pharmacy benefit
50 management firms are required to show compliance with this section.
51 (5.5)".
52
53 Page 5, line 11, after "(5.7)" insert "and (5.9)".
54
55 Page 5, line 13, strike "enforcement." and substitute "enforcement -
56 rules.".
1 Page 5, after line 18 insert:
2
3 "(5.9) THE COMMISSIONER MAY ADOPT RULES TO IMPLEMENT AND
4 ENFORCE THIS SECTION.".
5
6 Page 5, line 20, strike "(4)" and substitute "(4); and add (6)".
7
8 Page 5, line 23, strike "law." and substitute "law - rules.".
9
10 Page 6, after line 5 insert:
11
12 "(6) THE COMMISSIONER MAY ADOPT RULES TO IMPLEMENT AND
13 ENFORCE THIS SECTION.".
14
15 Page 6, line 7, after "(1.5)" insert "and (1.7)".
16
17 Page 6, line 9, strike "definitions." and substitute "definitions - rules.".
18
19 Page 6, after line 13 insert:
20
21 "(1.7) THE COMMISSIONER MAY ADOPT RULES TO IMPLEMENT AND
22 ENFORCE THIS SECTION.".
23
24 Amendment No. 5, by Representative Jodeh:
25
26 Amend proposed floor amendment (HB1227_L.003), page 1, line 3,
27 strike ""THIS" and substitute ""NOTWITHSTANDING THE DEFINITION OF A
28 PBM IN SECTION 10-16-102 (49), THIS".
29
30 Page 1 of the amendment, strike lines 5 through 8 and substitute "THAT
31 IS NOT DIRECTLY CONNECTED WITH A CARRIER.".".
32
33 As amended, ordered engrossed and placed on the Calendar for Third
34 Reading and Final Passage.
Senate Journal, April 20
After consideration on the merits, the Committee recommends that HB23-1227 be
amended as follows, and as so amended, be referred to the Committee on Finance with
favorable recommendation.
Amend reengrossed bill, page 3, line 18, after "RULE." add "THE COMMISSIONER
SHALL SET REGISTRATION FEES AT AMOUNTS THAT ARE COMMENSURATE WITH
THE AMOUNTS OF REGISTRATION FEES ASSESSED IN OTHER STATES.".
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