HB23-1225 Summary

• Modifies drug identification criteria for affordability review by lowering the initial wholesale acquisition cost threshold from $30,000 to $3,000 and adding new triggers for price increases of $300 or more or 200% or more over 12 months.

• Allows the board to establish upper payment limits for up to 18 prescription drugs per year (instead of 12) if the board determines a need exists and has sufficient staff support.

• Clarifies that drug selection and affordability determinations are not subject to judicial review, while upper payment limit rules are subject to judicial review under the State Administrative Procedure Act.

• Authorizes individuals to request independent external review when denied benefits for a prescription drug withdrawn from sale or distribution in Colorado.

• Extends the repeal date of the Prescription Drug Affordability Board from September 1, 2026 to September 1, 2031.