First Regular Session
Sixty-second General Assembly
LLS NO. 99-0740.01 Pam Cybyske HOUSE BILL 99-1352
STATE OF COLORADO
BY REPRESENTATIVES Hoppe, Bacon, Coleman, George, Gordon,
Gotlieb, Johnson, Kaufman, Keller, Kester, Larson, Leyba, Mace, Miller,
Plant, Saliman, Smith, Spradley, Takis, Tapia, Tate, Taylor, Tochtrop,
Tool, Veiga, Vigil, Webster, Windels, and Zimmerman;
also SENATORS Musgrave, Chlouber, Dennis, Dyer, Feeley, Hillman,
Martinez, Matsunaka, Perlmutter, Phillips, Rupert, Tebedo, Thiebaut,
Wattenberg, and Weddig.
BUSINESS AFFAIRS AND LABOR
A BILL FOR AN ACT
101 CONCERNING A PROHIBITION ON ENTITIES THAT ADMINISTER PRESCRIPTION
102 DRUG BENEFITS IN CONNECTION WITH A MANAGED CARE PLAN
103 FROM IMPOSING DIFFERENT CONDITIONS UPON COVERED PERSONS
104 FOR PRESCRIPTION DRUGS OBTAINED THROUGH MAIL ORDER
105 PHARMACY PROVIDERS.
Bill Summary
(Note: This summary applies to this bill as introduced and does
not necessarily reflect any amendments that may be subsequently
adopted.)
Declares that by making mail order pharmacies more attractive to
Colorado consumers, the pharmacy benefit managers are discouraging
such consumers from using Colorado business in favor of out-of-state
business.
Defines "pharmacy benefit management firm".
Prohibits a pharmacy benefit management firm or intermediary
that administers prescription drug benefits in connection with a managed
care plan from imposing different conditions upon covered persons for
prescription drugs obtained through mail order pharmacy providers.
Requires a pharmacy benefit management firm or intermediary to
identify all retail pharmacy providers from whom such covered persons
are authorized to obtain prescription drug benefits in any list of
participating providers furnished to covered persons under a managed
care plan.
[ ] denotes HOUSE amendment. { } denotes SENATE amendment.
Capital letters indicate new material to be added to existing statute.
Dashes through the words indicate material to be deleted from existing statute.
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1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. Legislative declaration. (1) The general assembly
3 hereby finds, determines, and declares that:
4 (a) Pharmacy benefit managers contract with Colorado employers
5 and insurance companies to design pharmacy benefit plans to provide
6 prescription drug benefits to Colorado citizens; and
7 (b) Pharmacy benefit managers sometimes impose different
8 copayments for retail prescriptions than for mail order prescriptions
9 making the latter more attractive to Colorado consumers; and
10 (c) Even if the copayment for the retail prescriptions and the mail
11 order prescriptions are the same, the pharmacy benefit manager may
12 allow the Colorado consumer to receive only a thirty day prescription
13 drug supply through a retail pharmacy while he or she may receive a
14 ninety day supply through a mail order pharmacy which drives market
15 share to mail order pharmacies; and
16 (d) Most mail order pharmacies that do business in Colorado are
17 out-of-state companies; and
18 (e) Out-of-state mail order pharmacies that do business in
19 Colorado are not licensed by but are only registered with the Colorado
20 board of pharmacy and are not required to follow Colorado pharmacy
21 practice regulations; and
22 (f) By making mail order pharmacies more attractive to Colorado
23 consumers, the pharmacy benefit managers are discouraging such
24 consumers from using Colorado businesses in favor of out-of-state
25 businesses; and
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1 (g) The practice of making mail order pharmacies more attractive
2 than Colorado businesses to Colorado consumers is jeopardizing
3 Colorado businesses; and
4 (h) Allowing pharmacy benefit managers to use differential
5 copayments and conditions to coerce consumers to take their
6 prescriptions to out-of-state businesses is harmful to the Colorado
7 economy and therefore shall be prohibited.
8 SECTION 2. 10-16-102, Colorado Revised Statutes, is amended
9 BY THE ADDITION OF A NEW SUBSECTION to read:
10 10-16-102. Definitions. As used in this article, unless the context
11 otherwise requires:
12 (29.5) "PHARMACY BENEFIT MANAGEMENT FIRM" MEANS ANY
13 ENTITY DOING BUSINESS IN THIS STATE THAT CONTRACTS TO ADMINISTER
14 OR MANAGE PRESCRIPTION DRUG BENEFITS ON BEHALF OF ANY CARRIER
15 THAT PROVIDES PRESCRIPTION DRUG BENEFITS TO THE RESIDENTS OF THIS
16 STATE.
17 SECTION 3. 10-16-122, Colorado Revised Statutes, is amended
18 BY THE ADDITION OF A NEW SUBSECTION to read:
19 10-16-122. Access to prescription drugs. (4) NO PHARMACY
20 BENEFIT MANAGEMENT FIRM OR INTERMEDIARY THAT CONTRACTS WITH A
21 CARRIER TO ADMINISTER OR MANAGE PRESCRIPTION DRUG BENEFITS IN
22 CONNECTION WITH A MANAGED CARE PLAN SHALL IMPOSE UPON COVERED
23 PERSONS DIFFERENT COPAYMENTS OR CONDITIONS FOR PRESCRIPTION
24 DRUGS OBTAINED THROUGH MAIL ORDER PHARMACY PROVIDERS. ANY
25 LIST OF PARTICIPATING PROVIDERS PROVIDED BY A PHARMACY BENEFIT
26 MANAGEMENT FIRM OR INTERMEDIARY TO COVERED PERSONS UNDER A
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1 MANAGED CARE PLAN SHALL IDENTIFY ALL RETAIL PHARMACY PROVIDERS
2 FROM WHOM SUCH COVERED PERSONS ARE AUTHORIZED TO OBTAIN
3 PRESCRIPTION DRUG BENEFITS.
4 SECTION 4. Effective date - applicability. (1) This act shall
5 take effect September 1, 1999, unless a referendum petition is filed during
6 the ninety-day period after final adjournment of the general assembly that
7 is allowed for submitting a referendum petition pursuant to article V,
8 section 1 (3) of the state constitution. If such a referendum petition is
9 filed against this act or an item, section, or part of this act within such
10 period, then the act, item, section, or part, if approved by the people, shall
11 take effect on the date of the official declaration of the vote thereon by
12 proclamation of the governor.
13 (2) The provisions of this act shall apply to all contracts for
14 pricing and terms for the administration of a prescription drug benefit
15 negotiated, renegotiated, or renewed by insurers subject to article 16 of
16 title 10, Colorado Revised Statutes, on or after the applicable effective
17 date of this act.