House Bill 26-1056 Introduced

A Bill for an Act

• Page 1, Line 101Concerning prescription drug sourcing provided pursuant to

• Page 1, Line 102a health benefit plan.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

The bill creates the "Prescription Drug Optimized Sourcing Transparency and Integrity Act" to prohibit a pharmacy benefit manager (PBM) or a health-care consultant from knowingly making or disseminating false or misleading statements or claims to a self-insured employer or policyholder about the legality or safety of a lawful prescription drug optimized sourcing program established by a pharmacy stewardship program.

Upon written request by a self-insured employer, a PBM or health-care consultant is required to provide certain cost information for each prescription drug dispensed under the health benefit plan.

The prohibition and information-sharing provisions of the bill do not restrict or limit the rights of a self-insured employer to purchase prescription drugs through and contract for a lawful prescription drug optimized sourcing program. The bill also recognizes that a pharmacy stewardship program is an effective cost-containment tool and is authorized when implemented in compliance with federal law and with the bill.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  Legislative declaration. (1)  The general assembly

• Page 2, Line 3finds and declares that:

• Page 2, Line 4(a)  Improving transparency and integrity in prescription drug

• Page 2, Line 5purchasing protects employers and health benefit plan sponsors, supports

• Page 2, Line 6patient safety, and reduces unnecessary costs, while preserving clinical

• Page 2, Line 7decision-making; and

• Page 2, Line 8(b)  It is the policy of this state to permit the lawful personal-use

• Page 2, Line 9importation of prescription drugs, otherwise known as pharmacy

• Page 2, Line 10stewardship programs, optimized sourcing, or international sourcing, in

• Page 2, Line 11order to reduce net plan costs without disrupting patient care.

• Page 2, Line 12SECTION 2.  In Colorado Revised Statutes, add 10-16-171 as

• Page 2, Line 13follows:

• Page 2, Line 1410-16-171.  Pharmacy benefit managers - health-care

• Page 2, Line 15consultants - prescription drug optimized sourcing - disclosure

• Page 2, Line 16requirements - enforcement - short title - definitions.

• Page 2, Line 17(1)  Short title.The short title of this section is the

• Page 2, Line 18"Prescription Drug Optimized Sourcing Transparency and

• Page 2, Line 19Integrity Act".

• Page 3, Line 1(2)  Definitions.As used in this section:

• Page 3, Line 2(a)  "Health-care consultant" means an individual or

• Page 3, Line 3entity that provides professional advice, analysis, or services

• Page 3, Line 4to a self-insured employer regarding health benefit plan design

• Page 3, Line 5or administration, including services related to prescription

• Page 3, Line 6drug benefits.

• Page 3, Line 7(b)  "National drug code" has the meaning set forth in

• Page 3, Line 8section 10-16-122.9 (2)(f).

• Page 3, Line 9(c) (I)  "Pharmacy stewardship program" means a program

• Page 3, Line 10operated by or on behalf of a self-insured employer to optimize

• Page 3, Line 11the financial performance of the self-insured employer's

• Page 3, Line 12pharmacy benefit while maintaining safety, continuity of

• Page 3, Line 13therapy, and equal or lower member cost share. Prescriptions

• Page 3, Line 14not fulfilled through the pharmacy stewardship program

• Page 3, Line 15continue to process under the health benefit plan's existing

• Page 3, Line 16pharmacy benefit manager, carrier, and network.

• Page 3, Line 17(II)  A "pharmacy stewardship program" includes the use of

• Page 3, Line 18optimized sourcing.

• Page 3, Line 19(III)  A "pharmacy stewardship program" is not:

• Page 3, Line 20(A)  Insurance or a policy of insurance;

• Page 3, Line 21(B)  A health plan;

• Page 3, Line 22(C)  A PBM; or

• Page 3, Line 23(D)  A third-party administrator.

• Page 3, Line 24(d) (I)  "Prescription drug optimized sourcing program"

• Page 3, Line 25means a lawful arrangement operated by or on behalf of a

• Page 3, Line 26self-insured employer under which a defined subset of

• Page 3, Line 27prescription drugs for covered persons may be dispensed

• Page 4, Line 1through channels other than the health benefit plan's

• Page 4, Line 2pharmacy benefit manager or carrier-administered network, if

• Page 4, Line 3authorized by federal law, to reduce the net plan cost while

• Page 4, Line 4maintaining patient safety, continuity of therapy, and equal or

• Page 4, Line 5lower member cost share. A prescription drug optimized sourcing

• Page 4, Line 6program is not insurance, and prescriptions not fulfilled

• Page 4, Line 7through the program continue to process under a plan's existing

• Page 4, Line 8pharmacy benefit manager, carrier, and network.

• Page 4, Line 9(II)  "Prescription drug optimized sourcing program"

• Page 4, Line 10includes a program for importing prescription drugs authorized

• Page 4, Line 11by federal law and FDA regulation.

• Page 4, Line 12(e)  "Self-insured employer" means an employer that offers

• Page 4, Line 13a self-insured health plan to its employees.

• Page 4, Line 14(3)  Prohibition against misinformation.A pharmacy benefit

• Page 4, Line 15manager or health-care consultant shall not knowingly make

• Page 4, Line 16or disseminate false or misleading statements or claims to an

• Page 4, Line 17employer, self-insured employer, or policyholder about the

• Page 4, Line 18legality or safety of a lawful prescription drug optimized

• Page 4, Line 19sourcing program established by a pharmacy stewardship

• Page 4, Line 20program.

• Page 4, Line 21(4)  Disclosure requirements.

• Page 4, Line 22(a)  Upon written request by a self-insured employer, a

• Page 4, Line 23pharmacy benefit manager or health-care consultant shall

• Page 4, Line 24provide detailed cost information for each prescription drug

• Page 4, Line 25dispensed under the plan, including:

• Page 4, Line 26(I)  Total drug cost per claim;

• Page 4, Line 27(II)  Total member-paid portion per claim;

• Page 5, Line 1(III)  Total plan-paid, sponsor-paid, or employer-paid

• Page 5, Line 2portion per claim; and

• Page 5, Line 3(IV)  National drug code, quantity, strength, and days of

• Page 5, Line 4supply.

• Page 5, Line 5(b)  A pharmacy benefit manager or health-care

• Page 5, Line 6consultant that provides cost information pursuant to

• Page 5, Line 7subsection (4)(a) of this section shall not withhold, edit, or

• Page 5, Line 8redact the information that the pharmacy benefit manager or

• Page 5, Line 9health-care consultant provides.

• Page 5, Line 10(5)  Self-insured employer rights.This section does not

• Page 5, Line 11restrict or limit the right of a self-insured employer to

• Page 5, Line 12purchase prescription drugs through a lawful prescription drug

• Page 5, Line 13optimized sourcing program. A self-insured employer retains the

• Page 5, Line 14right to contract for any lawful prescription drug optimized

• Page 5, Line 15sourcing program, including personal-use importation programs

• Page 5, Line 16permitted under federal law, for drugs used by the self-insured

• Page 5, Line 17employer's health benefit plan's covered persons.

• Page 5, Line 18(6)  Pharmacy stewardship programs.

• Page 5, Line 19(a)  A pharmacy stewardship program that is designed to

• Page 5, Line 20improve the cost-effectiveness of medication use while

• Page 5, Line 21maintaining patient safety is recognized as an effective

• Page 5, Line 22cost-containment tool.

• Page 5, Line 23(b)  Pharmacy stewardship programs and prescription drug

• Page 5, Line 24optimized sourcing programs are authorized by state law when

• Page 5, Line 25implemented in compliance with federal law and with this

• Page 5, Line 26section. Such authorized programs include programs for

• Page 5, Line 27importing prescription drugs when authorized under federal

• Page 6, Line 1law.

• Page 6, Line 2(c)  Nothing in this section shall be construed to create a

• Page 6, Line 3new insurance product or mandatory coverage.

• Page 6, Line 4(7)  No state cost or self-insured employer mandate.

• Page 6, Line 5(a)  This section does not:

• Page 6, Line 6(I)  Create a fiscal requirement for any state agency or an

• Page 6, Line 7appropriation from the general fund;

• Page 6, Line 8(II)  Require an employer to adopt or participate in a

• Page 6, Line 9prescription drug optimized sourcing program or pharmacy

• Page 6, Line 10stewardship program; or

• Page 6, Line 11(III)  Require that resources be expended as a result of this

• Page 6, Line 12section.

• Page 6, Line 13(b)  The commissioner shall implement this section within

• Page 6, Line 14existing appropriations.

• Page 6, Line 15(8)  Enforcement.The commissioner shall enforce this

• Page 6, Line 16section with respect to a PBM or health-care consultant that

• Page 6, Line 17administers or manages prescription drug benefits for a health

• Page 6, Line 18benefit plan. A violation of this section by a PBM or a

• Page 6, Line 19health-care consultant is an unfair method of competition and

• Page 6, Line 20an unfair or deceptive act or practice in the business of

• Page 6, Line 21insurance pursuant to section 10-3-1104 (1)(uu). Each day during

• Page 6, Line 22which a violation continues constitutes a separate violation.

• Page 6, Line 23SECTION 3.  In Colorado Revised Statutes, 10-3-1104, add

• Page 6, Line 24(1)(uu) as follows:

• Page 6, Line 2510-3-1104.  Unfair methods of competition - unfair or deceptive

• Page 6, Line 26practices - rules - definitions. (1)  The following are defined as unfair

• Page 6, Line 27methods of competition and unfair or deceptive acts or practices in the

• Page 7, Line 1business of insurance:

• Page 7, Line 2(uu)  Violating section 10-16-171.

• Page 7, Line 3SECTION 4.  Act subject to petition - effective date -

• Page 7, Line 4applicability. (1)  This act takes effect at 12:01 a.m. on the day following

• Page 7, Line 5the expiration of the ninety-day period after final adjournment of the

• Page 7, Line 6general assembly (August 12, 2026, if adjournment sine die is on May 13,

• Page 7, Line 72026); except that, if a referendum petition is filed pursuant to section 1

• Page 7, Line 8(3) of article V of the state constitution against this act or an item, section,

• Page 7, Line 9or part of this act within such period, then the act, item, section, or part

• Page 7, Line 10will not take effect unless approved by the people at the general election

• Page 7, Line 11to be held in November 2026 and, in such case, will take effect on the

• Page 7, Line 12date of the official declaration of the vote thereon by the governor.

• Page 7, Line 13(2)  This act applies to conduct or omissions occurring on or after

• Page 7, Line 14the applicable effective date of this act.