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Bill Detail: HB22-1370

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Title Coverage Requirements For Health-care Products
Status Governor Signed (05/18/2022)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors E. Sirota (D)
I. Jodeh (D)
Senate Sponsors J. Buckner (D)
F. Winter (D)
House Committee Health and Insurance
Senate Committee State, Veterans and Military Affairs
Date Introduced 04/13/2022
Summary

Beginning in 2023, the bill requires each health insurance carrier
(carrier) that offers an individual or small group health benefit plan in this
state to offer at least 25% of its health benefit plans on the Colorado
health benefit exchange (exchange) and at least 25% of its plans not on
the exchange in each bronze, silver, gold, and platinum benefit level in
each service area as copayment-only payment structures for all

prescription drug cost tiers.
Starting in 2024, a carrier or, if a carrier uses a pharmacy benefit
manager (PBM) for claims processing services or other prescription drug
or device services under a health benefit plan offered by the carrier, the
PBM, or a representative of the carrier or the PBM, is prohibited from
modifying or applying a modification to the current prescription drug
formulary during the current plan year.
The bill repeals and reenacts the current requirements for step
therapy and requires a carrier to use clinical review criteria to establish
the step-therapy protocol.
For each health benefit plan issued or renewed on or after January
1, 2024, the bill requires each carrier or PBM to demonstrate to the
division of insurance that:
  • 100% of the estimated rebates received or to be received in
connection with dispensing or administering prescription
drugs included in the carrier's prescription drug formulary
are used to reduce costs for the employer or individual
purchasing the plan;
  • For small group and large employer health benefit plans, all
rebates are used to reduce employer and individual
employee costs; and
  • For individual health benefit plans, all rebates are used to
reduce consumers' premiums and out-of-pocket costs for
prescription drugs to the extent practicable.
The bill requires the commissioner of insurance (commissioner)
to promulgate rules to implement prescription drug pass-through
requirements for carriers. Each carrier or PBM is required to report
annually specified prescription drug rebate information to the
commissioner.
Beginning in 2023, the bill requires the department of health care
policy and financing, in collaboration with the administrator of the
all-payer claims database, to conduct an annual analysis of the
prescription drug rebates received in the previous calendar year, by carrier
and prescription drug tier, and make the analysis available to the public.

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