Colorado Prescription Drug Cost Reduction Act of 2019 (HB 19-1296)

• Creates mandatory reporting requirements for health insurers, prescription drug manufacturers, pharmacy benefit management firms (PBMs), and nonprofits to disclose prescription drug costs, rebates, and pricing information to the Colorado Commissioner of Insurance starting in 2020.

• Requires drug manufacturers to notify purchasers and the commissioner of prescription drug price increases exceeding specified thresholds (10% over 12 months or 16% over 24 months) at least 30 days before implementation, with enhanced notification requirements for essential drugs.

• Prohibits PBMs from retroactively reducing pharmacy payments on clean claims except through audits that determine claims are invalid, and requires health insurers to ensure PBM compliance with this restriction and reporting requirements.

• Mandates carriers reduce consumer cost sharing for prescription drugs by at least 51% of average rebates received or ensure cost sharing does not exceed 125% of the carrier's drug cost, effective January 1, 2021.

• Establishes enforcement penalties of up to $10,000 per day for manufacturers and health insurers that fail to comply with notification and reporting requirements, with violations subject to discipline by the state board of pharmacy.