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 3(f) State attorneys general have sued PBMs for over-inflating
Page 3, Line 4prescription drug costs for state medicaid programs, and the over-inflated
Page 3, Line 5prescription drug costs drive up costs for taxpayers by hundreds of millions of dollars;
Page 3, Line 6(g) The federal house committee on oversight and accountability
Page 3, Line 7found that the 3 largest PBMs control 80% of the market and have used
Page 3, Line 8their position to enact anticompetitive policies, share patient information,
Page 3, Line 9steer patients to PBM-owned pharmacies, and artificially reduce reimbursements to rural independent pharmacies;
Page 3, Line 10(h) The federal trade commission has reported that PBM practices
Page 3, Line 11inflate drug costs, squeeze independent pharmacies, and deprive consumers of affordable, accessible health care;
Page 3, Line 12(i) A recent audit by the state of Mississippi found that PBMs
Page 3, Line 13excessively audited pharmacies and reimbursed rural independent
Page 3, Line 14pharmacies 145% less than they paid their own PBM-affiliated pharmacy for the same drug;
Page 3, Line 15(j) Rural independent pharmacies offer a wide variety of
Page 3, Line 16health-care services, ranging from prescription drug delivery; special drug
Page 3, Line 17packaging for vulnerable populations; medication management; wellness
Page 3, Line 18and prevention services; immunizations; chronic and acute care
Page 3, Line 19management; testing and treatment for strep throat, flu, and COVID-19;
Page 3, Line 20blood pressure and glucose screenings; and diabetes education and
Page 3, Line 21management, and provide health-care services for hospitals, long-term
Page 3, Line 22care facilities, and health clinics; and
Page 4, Line 1(k) When rural independent pharmacies close, patients lose access
Page 4, Line 2to care, communities lose health-care providers, and Coloradans are
Page 4, Line 3forced to travel greater distances to access care or are left completely without care.
Page 4, Line 4(2) Therefore, the general assembly declares that Colorado must
Page 4, Line 5preserve access to rural independent pharmacies for the state's rural communities and its most vulnerable populations.
Page 4, Line 6SECTION 2. In Colorado Revised Statutes, 10-16-102, add (59.5) as follows:
Page 4, Line 710-16-102. Definitions. As used in this article 16, unless the context otherwise requires:
Page 4, Line 8(59.5) "Rural independent pharmacy" means a prescription drug outlet that is:
Page 4, Line 9(a) Privately owned by at least one licensed pharmacist
Page 4, Line 10with no ownership interest by or affiliation with a chain pharmacy or a publicly traded prescription drug outlet; or
Page 4, Line 11(b) Located in a county with a population of less than
Page 4, Line 12fifty thousand residents or a municipality with a population of
Page 4, Line 13less than twenty-five thousand residents if the municipality is
Page 4, Line 14not contiguous to a municipality with a population of twenty-five thousand or more residents.
Page 4, Line 15SECTION 3. In Colorado Revised Statutes, 10-16-122.1, amend (3) introductory portion; and add (3)(d) as follows:
Page 4, Line 1610-16-122.1. Contracts between PBMs and pharmacies -
Page 4, Line 17carrier submit list of PBMs - PBM registration - fees - prohibited
Page 4, Line 18practices - exception - rules - enforcement - short title - definitions.
Page 4, Line 19(3)
Starting in 2022,Page 5, Line 1(d) (I) Prohibit a rural independent pharmacy from using
Page 5, Line 2a private courier or a delivery service to deliver a prescription drug to a patient; or
Page 5, Line 3(II) Require a rural independent pharmacy to obtain
Page 5, Line 4consent from the PBM to use a private courier or delivery service to deliver a prescription drug to a patient.
Page 5, Line 5SECTION 4. In Colorado Revised Statutes, 10-16-122.3, add (1.5), (6)(a.5), and (6)(b.3) as follows:
Page 5, Line 610-16-122.3. Pharmacy benefit management firm payments -
Page 5, Line 7retroactive reduction prohibited - enforcement - rules - definitions.
Page 5, Line 8(1.5) (a) A pharmacy benefit management firm shall reimburse a
Page 5, Line 9rural independent pharmacy for a prescription drug in an
Page 5, Line 10amount not less than the average acquisition cost of a prescription drug plus a dispensing fee.
Page 5, Line 11(b) A pharmacy benefit management firm shall pay a rural
Page 5, Line 12independent pharmacy a dispensing fee, which fee is determined
Page 5, Line 13by the medical services board in the state department of health
Page 5, Line 14care policy and financing, in an amount not less than the dispensing fee for rural pharmacies.
Page 5, Line 15(6) As used in this section:
Page 5, Line 16(a.5) "Average acquisition cost" means the average
Page 5, Line 17acquisition cost for like prescription drugs, as determined by the
Page 5, Line 18medical services board in the state department of health care policy and financing.
Page 5, Line 19(b.3) (I) "Dispensing fee" means the reimbursement amount
Page 5, Line 20for costs associated with filling a prescription, as determined by
Page 5, Line 21the medical services board in the state department of health care policy and financing.
Page 6, Line 1(II) For the purposes of determining the dispensing fee for
Page 6, Line 2a rural pharmacy, the dispensing fee is the fee calculated by the
Page 6, Line 3medical services board as the dispensing fee for rural pharmacies.
Page 6, Line 4SECTION 5. In Colorado Revised Statutes, 10-16-122.5, amend (1)(e) and (1)(f); and add (1)(g) as follows:
Page 6, Line 510-16-122.5. Pharmacy benefit manager - audit of pharmacies
Page 6, Line 6- time limits on on-site audits - enforcement - rules. (1) A pharmacy
Page 6, Line 7benefit manager, a carrier, or an entity acting on behalf of a pharmacy benefit manager or a carrier that audits a pharmacy shall:
Page 6, Line 8(e) Establish a written appeals process that includes procedures to
Page 6, Line 9allow a pharmacy to appeal to the pharmacy benefit manager or the
Page 6, Line 10carrier the preliminary reports resulting from the audit and any resulting recoupment or penalty;
andPage 6, Line 11(f) Not subject a pharmacy to the recoupment of funds when an
Page 6, Line 12audit results in the identification of a clerical error in a required document
Page 6, Line 13or record unless the error results in actual financial harm to the pharmacy
Page 6, Line 14benefit manager, a health benefit plan providing prescription drug
Page 6, Line 15benefits that are managed by the pharmacy benefit manager, or a consumer; and
Page 6, Line 16(g) When subjecting a rural independent pharmacy to a
Page 6, Line 17recoupment of funds, serve process on the rural independent
Page 6, Line 18pharmacy and notify the rural independent pharmacy of the
Page 6, Line 19rural independent pharmacy's rights to appeal pursuant to
Page 6, Line 20subsection (1)(e) of this section at least thirty days before the
Page 6, Line 21recoupment of funds when an audit results in a recoupment of
Page 7, Line 1more than one thousand dollars or a penalty of more than one thousand dollars.
Page 7, Line 2SECTION 6. In Colorado Revised Statutes, 12-280-103, add (17.5) and (46.7) as follows:
Page 7, Line 312-280-103. Definitions - rules. As used in this article 280, unless
Page 7, Line 4the context otherwise requires or the term is otherwise defined in another part of this article 280:
Page 7, Line 5(17.5) "Flex pharmacy" means a prescription drug outlet
Page 7, Line 6that operates as a telepharmacy when the licensed pharmacist is not on the premises.
Page 7, Line 7(46.7) "Rural independent pharmacy" has the meaning set forth in section 10-16-102 (59.5).
Page 7, Line 8SECTION 7. In Colorado Revised Statutes, add 12-280-118.5 as follows:
Page 7, Line 912-280-118.5. Flex pharmacy - fee - supervision - rules.
Page 7, Line 10(1) The board may adopt rules to specify additional criteria necessary to facilitate the operation of flex pharmacies.
Page 7, Line 11(2) The board shall assess a fee on a prescription drug
Page 7, Line 12outlet that applies to be a flex pharmacy so that the total fee
Page 7, Line 13amount collected is sufficient to cover the direct and indirect
Page 7, Line 14costs necessary for the board to facilitate the operation of flex pharmacies.
Page 7, Line 15(3) A flex pharmacy:
Page 7, Line 16(a) Shall be registered as a prescription drug outlet or pharmacy under this article 280;
Page 7, Line 17(b) Shall have a licensed pharmacist on the premises for
Page 7, Line 18at least twice the number of hours per calendar year that the flex pharmacy operates as a telepharmacy;
Page 8, Line 1(c) Shall operate as a telepharmacy from the same premises as the premises where the pharmacy is registered; and
Page 8, Line 2(d) Must be a rural independent pharmacy.
Page 8, Line 3(4) When a flex pharmacy operates as a telepharmacy, the
Page 8, Line 4central pharmacy responsible for overseeing the operation of
Page 8, Line 5the flex pharmacy must be affiliated with the flex pharmacy
Page 8, Line 6through common ownership or through a common professional
Page 8, Line 7pharmacy organization that offers support for telepharmacy supervision services.
Page 8, Line 8SECTION 8. Act subject to petition - effective date -
Page 8, Line 9applicability. (1) This act takes effect at 12:01 a.m. on the day following
Page 8, Line 10the expiration of the ninety-day period after final adjournment of the
Page 8, Line 11general assembly; except that, if a referendum petition is filed pursuant
Page 8, Line 12to section 1 (3) of article V of the state constitution against this act or an
Page 8, Line 13item, section, or part of this act within such period, then the act, item,
Page 8, Line 14section, or part will not take effect unless approved by the people at the
Page 8, Line 15general election to be held in November 2026 and, in such case, will take
Page 8, Line 16effect on the date of the official declaration of the vote thereon by the governor.
Page 8, Line 17(2) This act applies to conduct occurring on or after the applicable effective date of this act.