HB 21-1237: Colorado Competitive Pharmacy Benefit Managers Marketplace

• Creates a competitive reverse auction process for the Department of Personnel to procure pharmacy benefit manager (PBM) services for the State Employees Group Benefits Act plan, with the first auction to be completed by July 1, 2023.

• Requires the Department to procure a technology platform by November 1, 2022 that can conduct automated online auctions, evaluate PBM pricing proposals in real-time, and perform real-time electronic line-by-line review of 100% of invoiced PBM prescription drug claims.

• Prohibits awarding the technology platform contract to any PBM or PBM-affiliated vendor and requires the winning PBM to pay per-prescription fees to the technology operator rather than the state incurring costs.

• Allows other self-funded public sector health plans and, after the first auction, self-funded private sector health plans to participate in joint purchasing pools with the state employees plan while retaining autonomy over their own formularies and benefit designs.

• Permits the Department to conduct periodic "market checks" during contract terms and to vacate auction outcomes if the lowest bid does not represent projected savings compared to the incumbent PBM contract.