2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1405 - Colorado prescription drug affordability review board - reports from carriers and pharmacy benefit management firms required - confidential materials

(1)
Beginning in the 2022 calendar year, for all prescription drugs dispensed at a pharmacy in this state and paid for by a carrier pursuant to a health benefit plan issued under part 2, 3, or 4 of this article 16 during the immediately preceding calendar year, including brand-name drugs, authorized generic drugs, biological products, and biosimilar drugs:
(a)
Each carrier and each pharmacy benefit management firm acting on behalf of a carrier shall report to the all-payer health claims database the following information:
(I)
The top fifteen prescription drugs by volume, calculated by unit, for which the carrier paid;
(II)
The fifteen costliest prescription drugs for which the carrier paid, as determined by total annual plan spending;
(III)
The fifteen prescription drugs paid for by the carrier that accounted for the highest increase in total annual plan spending when compared with the total annual plan spending for the same prescription drugs in the year immediately preceding the year for which the information is reported;
(IV)
The fifteen prescription drugs that caused the greatest increases in the carrier's premiums;
(V)
The fifteen prescription drugs for which the carrier paid most frequently and for which the carrier received a rebate from manufacturers;
(VI)
The fifteen prescription drugs for which the carrier received the highest rebates, as determined by percentages of the price of the prescription drug;
(VII)
The fifteen prescription drugs for which the carrier received the largest rebates;
(VIII)
The total spending for each of the following categories of prescription drugs:
(A)
Brand-name drugs purchased from retail pharmacies;
(B)
Authorized generic drugs purchased from retail pharmacies;
(C)
Brand-name drugs purchased from mail-order pharmacies;
(D)
Authorized generic drugs purchased from mail-order pharmacies;
(E)
Prescription drugs dispensed by a practitioner in accordance with section
12-280-120 (6)
;
(F)
Prescription drugs administered in an inpatient hospital setting; and
(G)
Prescription drugs administered in an outpatient hospital setting; and
(IX)
The total spending for the prescription drugs described in subsection (1)(a)(VIII) of this section paid for by a carrier pursuant to a health benefit plan issued under part 2, 3, or 4 of this article 16 during the immediately preceding calendar year for each of the following market sectors:
(A)
Individual;
(B)
Small employer; and
(C)
Large employer.
(b)
If the all-payer health claims database does not collect and maintain the data that is required to be reported to the database pursuant to subsection (1)(a) of this section, the administrator of the all-payer health claims database shall amend the requirements regarding the data to be submitted to the database pursuant to section
25.5-1-204 (5)
to include the data required by subsection (1)(a) of this section during the next update of such requirements, but no later than June 1, 2022.
(2)
The administrator of the all-payer health claims database shall provide to the commissioner, in a form and manner determined by the commissioner, the information that is reported to the database by carriers and pharmacy benefit management firms pursuant to subsection (1)(a) of this section.
(3)
(a)
Except as provided in subsection (3)(b) of this section, the commissioner shall:
(I)
Post the information reported by carriers and pharmacy benefit management firms pursuant to this section on the division's website; and
(II)
Provide the information reported by carriers and pharmacy benefit management firms pursuant to this section to the board, in a form and manner prescribed by the board.
(b)
If a carrier or pharmacy benefit management firm claims that information submitted pursuant to this section is confidential or proprietary, the commissioner shall review the information and redact specific items that the carrier or pharmacy benefit management firm demonstrates to be confidential or proprietary. The commissioner shall not disclose redacted items to any person; except that the commissioner may disclose redacted items:
(I)
As may be required pursuant to the "Colorado Open Records Act", part 2 of article
72
of title
24
; and
(II)
To employees of the division, as necessary.
(4)
The requirement in this section to report information relating to the cost of prescription drugs is intended to create transparency in prescription drug pricing and does not:
(a)
Prohibit a manufacturer of a prescription drug from making pricing decisions about its prescription drugs; or
(b)
Prohibit purchasers, both public and private, or pharmacy benefit management firms from negotiating discounts and rebates consistent with existing state and federal law.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.