Senator Winter, bill sponsor, presented House Bill 20-1078. The bill establishes certain requirements concerning the rates paid by pharmacy benefit management (PBM) firms to pharmacies. It applies to contracts between pharmacies and PBM firms in effect beginning January 1, 2021. Specifically, the bill states that a PBM firm:
- cannot reimburse a clean claim from a pharmacy any less than the firm reimburses any affiliate for the same services;
- cannot reimburse a pharmacy less than four dollars for a reasonable dispensing fee;
- must reimburse a clean claim using a methodology described in the bill; and
- may not retroactively reduce payment on a clean claim submitted by a pharmacy. Insurance carriers must annually audit contracted PBM firms for compliance.
Failure to do so is designated as an unfair method of competition and an unfair or deceptive act in the business of insurance.