A Bill for an Act
Page 1, Line 101Concerning measures to preserve health-care access
Page 1, Line 102provided by rural independent pharmacies.
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 prevents a pharmacy benefit manager (PBM) from prohibiting a rural independent pharmacy from using a private courier or a delivery service to deliver a prescription drug to a patient.
A PBM is required to reimburse a rural independent pharmacy for a prescription drug in an amount not less than the average acquisition cost for like prescription drugs, as determined by the medical services board in the state department of health care policy and financing, plus pay a dispensing fee.
When a PBM conducts an audit of a rural independent pharmacy and the audit results in a recoupment of more than $1,000 or a penalty of more than $1,000, the PBM must serve process on the rural independent pharmacy and notify the rural independent pharmacy of the rural independent pharmacy's appeal rights at least 30 days before any recoupment of funds.
The bill defines "flex pharmacy" as a prescription drug outlet that:
- Is registered with the state board of pharmacy (board) as a prescription drug outlet;
- Operates as a telepharmacy during times when the licensed pharmacist is not on the premises;
- Has a licensed pharmacist on the premises for at least twice the number of hours that the flex pharmacy operates as a telepharmacy;
- Operates as a telepharmacy from the same premises as the premises where the pharmacy is registered; and
- Is a rural independent pharmacy.
The board may adopt rules to facilitate the operation of flex pharmacies and may assess a fee on a prescription drug outlet applying to be a flex pharmacy.
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 finds and determines that:
Page 2, Line 3(a) Rural independent pharmacies are critical to the provision of
Page 2, Line 4health-care services for Colorado's rural communities and vulnerable populations;
Page 2, Line 5(b) Nationally, one in 3 pharmacies have closed in the last decade;
Page 2, Line 6(c) A 2024 study of pharmacy closures found that 41% of the
Page 2, Line 7state's pharmacy closures were independent pharmacies, with the majority of those closures located in rural areas of the state;
Page 2, Line 8(d) Rural independent pharmacies have higher rates of permanent
Page 2, Line 9closure and report low reimbursement rates from pharmacy benefit
Page 2, Line 10managers, or "PBMs", as the key contributing factor;
Page 3, Line 1(e) Nationally, PBMs are under scrutiny for restricting consumer
Page 3, Line 2choice, steering patients to select pharmacies, and reimbursing rural independent pharmacies below cost;
Page 3, Line 4(f) Rural independent pharmacies offer a wide variety of
Page 3, Line 5health-care services, ranging from prescription drug delivery; special drug
Page 3, Line 6packaging for vulnerable populations; medication management; wellness
Page 3, Line 7and prevention services; immunizations; chronic and acute care
Page 3, Line 8management; testing and treatment for strep throat, flu, and COVID-19;
Page 3, Line 9blood pressure and glucose screenings; and diabetes education and
Page 3, Line 10management, and provide health-care services for hospitals, long-term care facilities, and health clinics; and
Page 3, Line 11(g) When rural independent pharmacies close, patients lose access
Page 3, Line 12to care, communities lose health-care providers, and Coloradans are
Page 3, Line 13forced to travel greater distances to access care or are left completely without care.
Page 3, Line 14(2) Therefore, the general assembly declares that Colorado must
Page 3, Line 15preserve access to rural independent pharmacies for the state's rural communities and its most vulnerable populations.
Page 3, Line 16SECTION 2. In Colorado Revised Statutes, 10-16-102, add (59.5) as follows:
Page 3, Line 1710-16-102. Definitions. As used in this article 16, unless the context otherwise requires:
Page 3, Line 18(59.5) "Rural independent pharmacy" means a prescription
Page 3, Line 19drug outlet that is privately owned by at least one licensed
Page 3, Line 20pharmacist with no ownership interest by or affiliation with a
Page 3, Line 21chain pharmacy or a publicly traded prescription drug outlet.
Page 4, Line 1SECTION 3. In Colorado Revised Statutes, 10-16-122.1, amend (3) introductory portion; and add (3)(d) as follows:
Page 4, Line 210-16-122.1. Contracts between PBMs and pharmacies -
Page 4, Line 3carrier submit list of PBMs - PBM registration - fees - prohibited
Page 4, Line 4practices - exception - rules - enforcement - short title - definitions.(3)
Starting in 2022,Page 4, Line 5(d) (I) Prohibit a rural independent pharmacy from using
Page 4, Line 6a private courier or a delivery service to deliver a prescription drug to a patient; or
Page 4, Line 7(II) Require a rural independent pharmacy to obtain
Page 4, Line 8consent from the PBM to use a private courier or delivery service to deliver a prescription drug to a patient.
Page 4, Line 9SECTION 4. In Colorado Revised Statutes, 10-16-122.3, add(1.5) and (6)(b.3) as follows:
Page 4, Line 1010-16-122.3. Pharmacy benefit management firm payments -
Page 4, Line 11retroactive reduction prohibited - enforcement - rules - dispensing
Page 4, Line 12fees - definitions.(1.5) On and after January 1, 2026, a pharmacy
Page 4, Line 13benefit management firm shall reimburse a rural independent
Page 4, Line 14pharmacy for a prescription drug in an amount not less than the
Page 4, Line 15national average drug acquisition cost for the dispensed
Page 4, Line 16prescription drug ingredients and a dispensing fee. If the
Page 4, Line 17national average drug acquisition cost is not available at the
Page 4, Line 18time a prescription drug is administered or dispensed, a pharmacy
Page 4, Line 19benefit management firm shall not reimburse in an amount that
Page 4, Line 20is less than the wholesale acquisition cost of the prescription drug.
Page 4, Line 21(6) As used in this section:
Page 5, Line 1(b.3) "Dispensing fee" means the reimbursement amount
Page 5, Line 2for costs associated with filling a prescription, as published for
Page 5, Line 3rural pharmacies in 10 CCR 2505-10 sec. 8.800.13.L, as the rule
Page 5, Line 4existed on June 1, 2025. On January 1, 2027, and on January 1 of
Page 5, Line 5every year thereafter, a pharmacy benefit management firm
Page 5, Line 6shall increase the amount of the dispensing fee by one percent to account for inflation.
Page 5, Line 7SECTION 5. In Colorado Revised Statutes, 10-16-122.5, amend (1)(e) and (1)(f); and add (1)(g) as follows:
Page 5, Line 810-16-122.5. Pharmacy benefit manager - audit of pharmacies
Page 5, Line 9- time limits on on-site audits - enforcement - rules. (1) A pharmacy
Page 5, Line 10benefit manager, a carrier, or an entity acting on behalf of a pharmacy benefit manager or a carrier that audits a pharmacy shall:
Page 5, Line 11(e) Establish a written appeals process that includes procedures to
Page 5, Line 12allow a pharmacy to appeal to the pharmacy benefit manager or the
Page 5, Line 13carrier the preliminary reports resulting from the audit and any resulting recoupment or penalty;
andPage 5, Line 14(f) Not subject a pharmacy to the recoupment of funds when an
Page 5, Line 15audit results in the identification of a clerical error in a required document
Page 5, Line 16or record unless the error results in actual financial harm to the pharmacy
Page 5, Line 17benefit manager, a health benefit plan providing prescription drug
Page 5, Line 18benefits that are managed by the pharmacy benefit manager, or a consumer; and
Page 5, Line 19(g) When subjecting a rural independent pharmacy to
Page 5, Line 20a recoupment of funds of more than one thousand dollars or a
Page 5, Line 21penalty of more than one thousand dollars as the result of an audit:
Page 6, Line 1(I) Electronically notify the rural independent pharmacy
Page 6, Line 2of the rural independent pharmacy's rights to appeal pursuant
Page 6, Line 3to subsection (1)(e) of this section at least thirty days before the recoupment of funds;
Page 6, Line 4(II) If the rural independent pharmacy does not respond
Page 6, Line 5to the electronic notification provided pursuant to subsection
Page 6, Line 6(1)(g)(I) of this section within thirty days after the electronic
Page 6, Line 7notification, again electronically notify the rural independent
Page 6, Line 8pharmacy of the rural independent pharmacy's rights to appeal
Page 6, Line 9pursuant to subsection (1)(e) of this section at least thirty days before the recoupment of funds; and
Page 6, Line 10(III) If the rural independent pharmacy does not respond
Page 6, Line 11to the second electronic notification provided pursuant to
Page 6, Line 12subsection (1)(g)(II) of this section within thirty days after the
Page 6, Line 13second electronic notification, serve process on the rural
Page 6, Line 14independent pharmacy notifying of the rural independent
Page 6, Line 15pharmacy's rights to appeal pursuant to subsection (1)(e) of this section at least thirty days before the recoupment of funds.
Page 6, Line 16SECTION 6. In Colorado Revised Statutes, 12-280-103, add (46.7) as follows:
Page 6, Line 1712-280-103. Definitions - rules. As used in this article 280, unless
Page 6, Line 18the context otherwise requires or the term is otherwise defined in another part of this article 280:
Page 6, Line 20(46.7) "Rural independent pharmacy" has the meaning set
Page 6, Line 21forth in section 10-16-102 (59.5).
Page 7, Line 1SECTION 7. In Colorado Revised Statutes, 12-280-118, add (3)(d) as follows:
Page 7, Line 212-280-118. Prescription drug outlet under charge of
Page 7, Line 3pharmacist - rules.(3) (d) A prescription drug outlet that is a
Page 7, Line 4rural independent pharmacy need not be under the direct
Page 7, Line 5charge of a pharmacist if the initial interpretation and final
Page 7, Line 6evaluation of the prescription is done by a pharmacist in person or remotely.
Page 7, Line 7SECTION 8. Act subject to petition - effective date -
Page 7, Line 8applicability. (1) Section 10-16-122.3, Colorado Revised Statutes, as
Page 7, Line 9amended in section 4 of this act, takes effect January 1, 2026, and the
Page 7, Line 10remainder of the act takes effect at 12:01 a.m. on the day following the
Page 7, Line 11expiration of the ninety-day period after final adjournment of the general
Page 7, Line 12assembly; except that, if a referendum petition is filed pursuant to section
Page 7, Line 131 (3) of article V of the state constitution against this act or an item,
Page 7, Line 14section, or part of this act within such period, then the act, item, section,
Page 7, Line 15or part will not take effect unless approved by the people at the general
Page 7, Line 16election to be held in November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.
Page 7, Line 17(2) This act applies to conduct occurring on or after the applicable effective date of this act.