HB 21-1297 Summary

• Establishes the "Pharmacy Fairness Act" to regulate pharmacy benefit managers (PBMs) in Colorado starting in 2022, requiring carriers to submit lists of contracted PBMs to the insurance commissioner

• Prohibits PBMs from restricting patients' access to in-network retail pharmacies unless the FDA has restricted drug distribution or the drug requires special handling that retail pharmacies cannot provide

• Limits PBM fees for pharmacist services claims to a one-time reasonable fee not exceeding the lesser of 25% of the pharmacy dispensing fee or 25 cents per claim

• Requires PBMs and carriers to provide real-time access to prescription drug benefit information including eligibility, cost-sharing details, alternative medications, and utilization management requirements using established industry standards

• Restricts PBMs from conducting on-site audits of pharmacies more frequently than once every 12 months and prohibits them from imposing accreditation standards stricter than those applied to PBM-affiliated pharmacies