As used in this part 14, unless the context otherwise requires: “Advisory council” means the Colorado prescription drug affordability advisory council created in section 10-16-1409. “Affordability review” means an affordability review of a prescription drug performed by the board pursuant to section 10-16-1406. “All-payer health claims database” means the all-payer health claims database described in […]
The Colorado prescription drug affordability review board is created in the division. The board is a body politic and corporate and is an instrumentality of the state. The board is an independent unit of state government, and the exercise by the board of its authority under this part 14 is an essential public function. The […]
To protect Colorado consumers from excessive prescription drug costs, the board shall: Collect and evaluate information concerning the cost of prescription drugs sold to Colorado consumers, as described in section 10-16-1405; Perform affordability reviews of prescription drugs, as described in section 10-16-1406; Establish upper payment limits for prescription drugs, as described in section 10-16-1407; and […]
The board shall hold its first meeting within six weeks after all of the board members are appointed and shall meet at least every six weeks thereafter to review prescription drugs; except that the chair may cancel or postpone a meeting if the board has no prescription drugs to review. The board is a state […]
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 […]
The board may conduct affordability reviews of prescription drugs in accordance with this section. The board shall identify, for purposes of determining whether to conduct an affordability review, any prescription drug that is: A brand-name drug or biological product that, as adjusted annually for inflation, has: An initial wholesale acquisition cost of thirty thousand dollars […]
The board may establish an upper payment limit for any prescription drug for which the board has performed an affordability review pursuant to section 10-16-1406 and determined that the use of the prescription drug is unaffordable for Colorado consumers; except that the board may not establish an upper payment limit for more than twelve prescription […]
A person aggrieved by a decision of the board may appeal the decision within sixty days after the decision is made. The board shall consider the appeal and issue a final decision concerning the appeal within sixty days after the board receives the appeal. Not later than March 31, 2022, the board shall promulgate rules […]
The Colorado prescription drug affordability advisory council is created in the division to provide stakeholder input to the board regarding the affordability of prescription drugs. The advisory council includes fifteen members as follows: The executive director of the department of health care policy and financing or the executive director’s designee; and Fourteen members appointed by […]
Any savings generated for a health benefit plan that are attributable to the establishment of an upper payment limit established by the board pursuant to section 10-16-1407 must be used by the carrier that issues the health benefit plan to reduce costs to consumers, prioritizing the reduction of out-of-pocket costs for prescription drugs. On or […]
On and after January 1, 2022, it is unlawful for any person to purchase or reimburse a payer for a prescription drug for which the board has established an upper payment limit pursuant to section 10-16-1407 at an amount that exceeds the upper payment limit established by the board for that prescription drug, regardless of […]
Any manufacturer that intends to withdraw from sale or distribution within the state a prescription drug for which the board has established an upper payment limit pursuant to section 10-16-1407 shall provide a notice of withdrawal in writing at least one hundred eighty days before the withdrawal to: The commissioner; The attorney general; and Each […]
An optional participating plan that elects to subject its purchases of or payer reimbursements for prescription drugs in Colorado to the requirements of this part 14 shall notify the commissioner in writing within thirty days after such election. Source: L. 2021: Entire part added, (SB 21-175), ch. 240, p. 1274, § 2, effective June 16.
Notwithstanding section 24-1-136 (11)(a), on or before July 1, 2023, and on or before July 1 each year thereafter, the board shall submit a report to the governor, the health and insurance committee of the house of representatives, and the health and human services committee of the senate, or to any successor committees, summarizing the […]
Notwithstanding any provision of this part 14 to the contrary, the board has no authority to perform an affordability review of, or to establish an upper payment limit for, any prescription drug that is derived in whole or in part from cannabis. Source: L. 2021: Entire part added, (SB 21-175), ch. 240, p. 1276, § […]
This part 14 is repealed, effective September 1, 2026. Before the repeal, the functions of the board are scheduled for review in accordance with section 24-34-104. Source: L. 2021: Entire part added, (SB 21-175), ch. 240, p. 1276, § 2, effective June 16.
