§ 24-50-1203 — Definitions

Colorado § 24-50-1203

• Jurisdiction: Colorado
• Title 24: Government
• Art.: State Personnel System -

Text

As used in this part 12, unless the context
otherwise requires:

(1) AWP means average wholesale price.

(2) Department means the department of personnel.

(3) GNC means guaranteed net cost.

(4) Market check means a technology-driven evaluation of an incumbent
PBM's prescription drug pricing based on benchmark comparators derived from
PBM reverse auction processes conducted in the United States over the previous
twelve months.

(5) NADAC means national average drug acquisition cost.

(6) NIST means national institute of standards and technology.

(7) Participant bidding agreement means an online agreement that details
common definitions, prescription drug classifications, rules, data access and use
rights, and other optimal contract terms benefitting the state that all PBM bidders
must accept as a prerequisite for participation in a PBM reverse auction.

(8) Pharmacy benefit manager or PBM means a person, business, or other
entity that, pursuant to a contract with a health-care service plan, manages, in
whole or through a coordination of service providers, the prescription drug
coverage provided by the health-care service plan, including, but not limited to, the
processing and payment of claims for prescription drugs, the performance of drug
utilization review, the processing of prior authorization requests for specified drugs,
the adjudication of appeals or grievances related to prescription drug coverage,
contracting with network pharmacies, and controlling the cost of covered
prescription drugs.

(9) PBM reverse auction means an automated, transparent, and
dynamically competitive bidding process conducted online that starts with an
opening round of bids and allows qualified PBM bidders to counter-offer a lower
price for as many rounds of bidding as determined by the department for a multiple
health plan prescription drug purchasing group.

(10) Price means the projected cost of a PBM offer or bid for providing
prescription drug benefits pursuant to this part 12, to enable direct comparison of
the comparably calculated costs of competing PBM proposals over the duration of
the PBM services contract.

(11) Real-time means within no more than one hour.

(12) Self-funded private sector health plan means any self-funded private
sector employer or multi-employer health plan.

(13) Self-funded public sector health plan means any group benefit plan
provided pursuant to the State Employees Group Benefits Act, part 6 of this
article 50; any state-funded health plan or self-funded county, municipal, or other
local government employee health plan; and any public school employee health
plan, health plan of the university of Colorado, Colorado public four-year college, or
Colorado community college system.

(14) SOC 2 means service organization control 2.

Legislative History

Source: L. 2021: Entire part added, (HB 21-1237), ch. 217, p. 1145, � 1, effective June 7.