Bill > HB1094

This bill introduces new regulations for Pharmacy Benefit Managers (PBMs) in Colorado aimed at reducing prescription drug costs and increasing transparency. The bill mandates that PBMs can only earn a single, flat-dollar service fee for prescription drug services, which can vary based on factors like the number of plan participants and services provided. PBMs are prohibited from generating income directly or indirectly based on prescription drug prices, such as through markup, up-charging, or spread-pricing. They cannot design drug formularies that favor branded pharmaceuticals over generic alternatives unless the branded drug has a lower net acquisition cost. The bill requires PBMs to be reimbursed for lowering overall prescription drug spending and for direct services provided to health benefit plans. PBMs must reimburse pharmacies at the national average drug acquisition cost plus a reasonable dispensing fee. Additionally, PBMs must disclose detailed prescription drug cost information to health benefit plans within 30 days and allow annual audits to validate compliance. The bill will take effect on January 1, 2027, subject to potential referendum, and is designed to create more transparency and fairness in prescription drug pricing and management.

Budget and Finance, Health and Social Services

https://leg.colorado.gov/bills/hb25-1094