HB 22-1370 Summary

• Requires health insurers offering individual and small group plans to provide copayment-only prescription drug payment structures for at least 25% of plans on and off the exchange in each benefit level (bronze, silver, gold, platinum) starting January 1, 2023.

• Prohibits carriers from modifying prescription drug formularies during a plan year for individual market plans starting in 2024, with limited exceptions for FDA safety warnings, over-the-counter approvals, generic/biosimilar additions, or high-cost drugs with significant price increases.

• Strengthens step therapy protections by requiring carriers to use clinical practice guidelines, establish expedited exception processes (3 business days or 24 hours for emergencies), and automatically grant exceptions if carriers fail to respond timely.

• Mandates health insurers pass 100% of manufacturer discounts and rebates to consumers through reduced premiums and out-of-pocket costs starting January 1, 2024, with special requirements for point-of-sale rebate application in individual plans.

• Appropriates $252,667 to the Division of Insurance for implementation and requires annual analysis of prescription drug rebates by the state department and all-payer health claims database.