Pharmacy Benefit Manager Prohibited Practices
The act enacts the "Colorado 340B Prescription Drug Program Anti-discrimination Act" (act), which prohibits health insurers, PBMs, and other third-party payers (third-party payers) from discriminating against entities participating in the federal 340B drug pricing program (340B covered entity), including a pharmacy that contracts with a 340B covered entity to provide dispensing services to the 340B entity (contract pharmacy). Specifically, the act prohibits a third-party payer from:
- Refusing to reimburse a 340B covered entity or contract pharmacy for dispensing 340B drugs, imposing additional requirements or restrictions on 340B covered entities or contract pharmacies, or reimbursing a 340B covered entity or contract pharmacy for a 340B drug at a rate lower than the amount paid for the same drug to pharmacies that are not 340B covered entities or contract pharmacies;
- Assessing a fee, charge back, or other adjustment against a 340B covered entity or contract pharmacy, or restricting a 340B covered entity's or contract pharmacy's access to the third-party payer's pharmacy network, because the 340B covered entity or contract pharmacy participates in the 340B drug pricing program;
- Requiring a 340B covered entity or contract pharmacy to contract with a specific pharmacy or health coverage plan in order to access the third-party payer's pharmacy network;
- Imposing a restriction or an additional charge on a patient who obtains a prescription drug from a 340B covered entity or contract pharmacy;
- Restricting the methods by which a 340B covered entity or contract pharmacy may dispense or deliver 340B drugs; or
- Requiring a claim for a 340B drug to include a modifier or other method of identifying the claim for a 340B drug.
A violation of the act is an unfair or deceptive act or practice in the business of insurance. The act authorizes the commissioner of insurance to adopt rules to implement the act.
The act appropriates $17,109 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the act.
(Note: This summary applies to this bill as enacted.)