2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-505 - [Effective 8/7/2024] Prescribed drugs - mail order - rules

(1)
(a)
(I)
The state board shall adopt by rule a system to allow medical assistance recipients the option to receive through the mail prescribed maintenance medications used to treat chronic medical conditions.
(II)
The state board rules must include the definition of maintenance medications. The rules may allow a medical assistance Member to receive through the mail up to a three-month supply, or the maximum allowed under federal law, of maintenance medications used to treat chronic medical conditions.
(b)
To the extent allowed by federal law, the state department shall require that a medical assistance Member receiving prescription medication through the mail pay the same copayment amount as a medical assistance Member receiving prescription medication through any other method. The state department shall encourage medical assistance members who choose to receive maintenance medications through the mail to use local retail pharmacies for mail delivery.
(c)
A pharmacy may provide maintenance medications through the mail to medical assistance recipients in accordance with all applicable state and federal laws if the pharmacy is enrolled as a provider with the state department and is registered with the state board of pharmacy, created and existing pursuant to section
12-280-104
.
(d)
A nonresident prescription drug outlet doing business in this state shall provide a means for recipients of state medical assistance who have third-party insurance with whom the nonresident prescription drug outlet has a contractual relationship to receive their required pharmacy benefits at a cost to the recipients of no more than the legally allowed state medical assistance copayment. If a third-party insurance carrier's copayment or deductible for pharmacy benefits is larger than the legally allowed state medical assistance copayment, the prescription drug outlet may bill the state medical assistance program for the difference pursuant to state medical assistance reimbursement rules.
(1.5)
The state department shall publish on its website and include in the Member handbook the following information for members enrolled in fee-for-service medical assistance programs:
(a)
That a medical assistance Member may use the pharmacy of the member's choice;
(b)
That a medical assistance Member may use a local retail pharmacy for mail delivery of maintenance medications, if offered; and
(c)
That the copayment amount for prescription medications is the same at any pharmacy enrolled in the medical assistance program.
(2)
The state department shall seek any federal authorization necessary to implement this section.
Amended by 2024 Ch. 152,§ 66, eff. 8/7/2024.
Amended by 2019 Ch. 136, § 187, eff. 10/1/2019.
Amended by 2016 Ch. 208, § 1, eff. 8/10/2016.
L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1. L. 2008: (1) amended, p. 890, § 1, effective May 20. L. 2009: (1)(a)(I)(B) amended, (SB 09-252), ch. 1228, p. 1228, § 1, effective May 18. L. 2016: (1) amended and (1.5) added, (SB 16-027), ch. 745, p. 745, § 1, effective August 10. L. 2019: (1)(c) amended, (HB 19-1172), ch. 1710, p. 1710, § 187, effective October 1.
This section is similar to former § 26-4-407.5 as it existed prior to 2006.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.