CO SB123

Allows covered persons to fill specialty drug and biological product prescriptions at a network pharmacy of their choice instead of a required mail-order or designated pharmacy if they provide proper notification to the PBM or carrier.

Proper notification requires the chosen pharmacy to provide an attestation that it can comply with applicable state and federal laws, manufacturer requirements, and U.S. Pharmacopeial Convention standards, and accepts the plan's payment terms for specialty drugs.

PBMs and carriers must process and pay claims for specialty drugs at chosen pharmacies in the same timely manner as other prescriptions and cannot charge different payment terms or provide incentives to use designated pharmacies.

PBMs and carriers must notify all covered persons of their right to choose a local pharmacy for specialty drugs, including notice in pharmacy network contracts and each explanation of benefits; pharmacists may also inform patients of these rights.

Violating the bill's requirements constitutes an unfair or deceptive insurance practice; the act takes effect January 1, 2017, and applies to health benefit plans issued, delivered, or renewed on or after that date.