Extend And Modify Prescription Drug Affordability Board

In 2021, the general assembly enacted Senate Bill 21-175, concerning the Colorado prescription drug affordability review board, which created the prescription drug affordability review board (board) in the division of insurance (division) and an affordability review process whereby the board may review costs associated with, and establish upper payment limits for, certain prescription drugs. The 2023 act makes certain changes concerning the board.

Section 1 clarifies which actions taken by the board are "board activities", as this term is used elsewhere. Section 2 states that staff members and contractors of the division must disclose any conflict of interest related to a prescription drug for which the board is conducting an affordability review or establishing an upper payment limit. Such a disclosure remains confidential if it relates to a personal association. The board, upon review of a disclosure, may direct the staff member or contractor of the division to recuse themselves.

Section 3 allows the chair of the board to cancel or postpone a board meeting for good cause. Section 4 makes certain changes to the procedure by which the board identifies prescription drugs that may be subjected to an affordability review, which changes take effect January 1, 2025, and requires the board to report on its public web page certain information regarding its considerations.

Under current law, the board may not establish an upper payment limit for more than 12 prescription drugs per calendar year for 3 years, beginning April 1, 2022. Section 5 lets the board establish an upper payment limit for up to 18 prescription drugs per calendar year if the board determines that there is a need and has sufficient staff support.

Section 6 establishes that an upper payment limit for a prescription drug is not a final agency action that is subject to judicial review until the board promulgates a rule establishing the upper payment limit. Sections 6 and 7 remove certain language concerning a process for appealing decisions of the board.

Sections 8 and 9 extend the repeal and associated sunset review of the board from September 1, 2026, to September 1, 2031.

Section 10 establishes that a denial of a request for benefits for a prescription drug that is unavailable in the state because a manufacturer has withdrawn the prescription drug from sale or distribution within the state is an "adverse determination" for which an individual may request an independent external review.

APPROVED by Governor May 10, 2023

PORTIONS EFFECTIVE August 7, 2023

PORTIONS EFFECTIVE January 1, 2025

NOTE: This act was passed without a safety clause and takes effect 90 days after sine die; except that, section 4 of the act takes effect January 1, 2025.
(Note: This summary applies to this bill as enacted.)