2020 Colorado Revised Statutes
Title 10 - Insurance
Article 16. Health Care Coverage
Section 10-16-122. Access to prescription drugs.
(1) Except as provided in section 25.5-5406.1 (1)(s), any pharmacy benefit management firm or intermediary whose contract with a carrier includes an open network shall allow participation by each pharmacy provider in the contract service area. If a pharmacy benefit management firm or intermediary offers an open network, the pharmacy benefit management firm or intermediary may offer such network on a regional or local basis.
For purposes of this section, "open network" means any pharmacy network createdby a pharmacy benefit management firm or intermediary through a contracting process with pharmacy providers that does not include competitive bidding and allows participation by any pharmacy provider that agrees to the terms and conditions of the contract offered by the pharmacy benefit management firm or intermediary.
A pharmacy benefit management firm or intermediary shall not be prohibited fromcontracting with exclusive pharmacy networks if, sixty days before the termination or effective date of an exclusive pharmacy network contract between the pharmacy providers and the pharmacy benefit management firm or intermediary, notice of such termination or of the effective date of an exclusive pharmacy network contract is published in one or more newspapers of general circulation in the affected contract service area. Notice shall include information about where in Colorado a copy of the pharmacy provider selection criteria may be obtained.
(a) No pharmacy benefit manager or carrier offering a managed care plan shall transfer or request that a pharmacy provider transfer the prescription or prescriptions of a covered person or subscriber, wholly or in part, to a different participating pharmacy provider than the provider selected by the covered person or subscriber unless one or more of the following conditions have been met:
The participating pharmacy provider to whom the covered person or subscriber's prescription is to be transferred or the carrier or pharmacy benefit manager has obtained a document, signed by the covered person or subscriber, that contains a clear, conspicuous, and unequivocal request by the covered person or subscriber for a change of provider;
The participating pharmacy provider carrier or pharmacy benefit manager to whomthe covered person or subscriber's prescription is to be transferred has obtained the covered person or subscriber's oral authorization for the transfer and is able to furnish proof of such authorization through verification by an independent third party or an electronic record; or
The pharmacy provider's participation in the pharmacy network of the carrier orpharmacy benefit manager has changed and the pharmacy provider selected by the covered person or subscriber is no longer a participating provider in the network, provided that the covered person or subscriber has been notified of the proposed transfer of pharmaceutical care services and is given an opportunity to affirmatively select a participating pharmacy provider other than the proposed transferee.
(b) Nothing in this subsection (4) shall require a carrier offering a managed care plan or a pharmacy benefit manager to pay for pharmaceutical benefits received from a nonparticipating provider.
Source: L. 98: Entire section added, p. 1188, § 1, effective August 5. L. 2001: (4) added, p. 1230, § 2, effective January 1, 2002. L. 2006: (1) amended, p. 1999, § 35, effective July 1. L. 2013: (1) amended, (HB 13-1266), ch. 217, p. 988, § 48, effective May 13. L. 2018: (1) amended, (HB 18-1431), ch. 313, p. 1891, § 8, effective August 8.
