CO HB1198

Requires health insurers (carriers) to submit lists of pharmacy benefit managers (PBMs) used for prescription drug benefits to the Colorado insurance commissioner starting in 2021, with updates within 10 business days of any changes.

Mandates carriers and PBMs to submit compensation programs for pharmacies/pharmacists and prescription drug formularies to the commissioner by the rate filing deadline, and allows the commissioner to review these programs for fairness and adequacy of pharmacy networks.

Prohibits carriers and PBMs from using deceptive advertising, charging pharmacies claim adjudication fees, imposing stricter accreditation standards than state board requirements, reimbursing independent pharmacies less than affiliated pharmacies for the same services, or modifying drug formularies during the benefit year.

Requires carriers and PBMs to file annual reports with the commissioner and the all-payer health claims database containing itemized claim data including amounts paid to pharmacists, pharmacy identities, prescription identifiers, and rebates received.

Makes carrier failure to comply with the law or ensure PBM compliance an unfair or deceptive insurance practice; holds carriers responsible for PBM compliance and authorizes the commissioner to audit carriers and PBMs for enforcement.