CO HB1094

HB 25-1094: Pharmacy Benefit Manager Practices

• Pharmacy benefit managers (PBMs) may only earn income through single, flat-dollar service fees transparently disclosed in written agreements with health benefit plans, not from drug price mark-ups, spread-pricing, or manufacturer-derived revenues.

• PBMs are prohibited from designing formularies that favor branded drugs over therapeutically equivalent generics or biosimilars, unless the branded drug has a lower net acquisition cost reflected in lower consumer out-of-pocket expenses.

• PBMs must reimburse pharmacies at the national average drug acquisition cost plus a reasonable dispensing fee, or at wholesale acquisition cost if national average data is unavailable.

• PBM contracts must require disclosure of prescription drug cost information, including claims-level pharmacy data, within 30 days of request, and must authorize annual compliance audits by health benefit plans.

• Effective date is January 1, 2027, subject to potential referendum.