CO HB1078

Pharmacy benefit management firms cannot reimburse pharmacies in amounts less than what they reimburse their affiliates for the same pharmacy services.

Pharmacy benefit management firms must not retroactively reduce payment on clean claims after the point of sale, except as a result of an audit conducted under section 10-16-122.5.

Pharmacy benefit management firms may retroactively increase payments or make clerical error adjustments if there is a written agreement with the pharmacy.

Carriers contracting with pharmacy benefit management firms must require compliance with these provisions in new, amended, or renewed contracts and must conduct annual audits to monitor compliance.

The law applies to contracts and agreements between pharmacy benefit management firms and pharmacies in effect on or after January 1, 2021.