CO HB1213

Defines "pharmacy benefit manager" as an entity contracting to administer or manage prescription drug benefits on behalf of carriers providing such benefits to Colorado residents, excluding the Department of Health Care Policy and Financing.

Requires pharmacy benefit managers to provide contracted pharmacies with a current list of sources used to determine maximum allowable cost pricing within ten days of request and update pricing information at least every seven days in an accessible format.

Establishes eligibility requirements for drugs on maximum allowable cost lists, including FDA approval ratings and general availability from national or regional wholesalers.

Mandates contracts include appeal processes with a 21-day limit to appeal, 21-day resolution timeline, dedicated telephone contact, written denial reasons, and drug code alternatives at or below benchmark prices.

Appropriates $129,831 ($44,519 from general fund and $85,312 from federal funds) to the Department of Health Care Policy and Financing for fiscal year 2014-2015 implementation costs; takes effect January 1, 2015.