§ 10-16-122 — Access to prescription drugs

Colorado § 10-16-122

• Jurisdiction: Colorado
• Title 10: Insurance
• Art.: Health-care Coverage

Text

(1) Except as provided in section
25.5-5-406.1 (1)(s), any pharmacy benefit management firm or intermediary whose
contract with a carrier includes an open network shall allow participation by each
pharmacy provider in the contract service area. If a pharmacy benefit management
firm or intermediary offers an open network, the pharmacy benefit management
firm or intermediary may offer such network on a regional or local basis.

(2) For purposes of this section, open network means any pharmacy
network created by a pharmacy benefit management firm or intermediary through a
contracting process with pharmacy providers that does not include competitive
bidding and allows participation by any pharmacy provider that agrees to the terms
and conditions of the contract offered by the pharmacy benefit management firm or
intermediary.

(3) A pharmacy benefit management firm or intermediary shall not be
prohibited from contracting with exclusive pharmacy networks if, sixty days before
the termination or effective date of an exclusive pharmacy network contract
between the pharmacy providers and the pharmacy benefit management firm or
intermediary, notice of such termination or of the effective date of an exclusive
pharmacy network contract is published in one or more newspapers of general
circulation in the affected contract service area. Notice shall include information
about where in Colorado a copy of the pharmacy provider selection criteria may be
obtained.

(4) (a) No pharmacy benefit manager or carrier offering a managed care plan
shall transfer or request that a pharmacy provider transfer the prescription or
prescriptions of a covered person or subscriber, wholly or in part, to a different
participating pharmacy provider than the provider selected by the covered person
or subscriber unless one or more of the following conditions have been met:

(I) The participating pharmacy provider to whom the covered person or
subscriber's prescription is to be transferred or the carrier or pharmacy benefit
manager has obtained a document, signed by the covered person or subscriber, that
contains a clear, conspicuous, and unequivocal request by the covered person or
subscriber for a change of provider;

(II) The participating pharmacy provider carrier or pharmacy benefit manager
to whom the covered person or subscriber's prescription is to be transferred has
obtained the covered person or subscriber's oral authorization for the transfer and
is able to furnish proof of such authorization through verification by an independent
third party or an electronic record; or

(III) The pharmacy provider's participation in the pharmacy network of the
carrier or pharmacy benefit manager has changed and the pharmacy provider
selected by the covered person or subscriber is no longer a participating provider in
the network, provided that the covered person or subscriber has been notified of
the proposed transfer of pharmaceutical care services and is given an opportunity
to affirmatively select a participating pharmacy provider other than the proposed
transferee.

(b) Nothing in this subsection (4) shall require a carrier offering a managed
care plan or a pharmacy benefit manager to pay for pharmaceutical benefits
received from a nonparticipating provider.

Legislative History

Source: L. 98: Entire section added, p. 1188, � 1, effective August 5. L. 2001: (4) added, p. 1230, � 2, effective January 1, 2002. L. 2006: (1) amended, p. 1999, � 35, effective July 1. L. 2013: (1) amended, (HB 13-1266), ch. 217, p. 988, � 48, effective May 13. L. 2018: (1) amended, (HB 18-1431), ch. 313, p. 1891, � 8, effective August 8.