(1) Beginning in 2023, the state department shall, in collaboration with the administrator of the all-payer health claims database described in section 25.5-1-204, conduct an annual analysis of the prescription drug rebates received in the previous calendar year, by health insurance carrier and prescription drug tier. The analysis, using data from the all-payer health claims database and other sources, must be completed on or before May 1 of each year.
(2) The state department shall make the analysis conducted in subsection (1) of this section available to the public on an annual basis.
Source: L. 2022: Entire section added, (HB 22-1370), ch. 184, p. 1237, � 7, effective August 10.
25.5-5-514. Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition. (1) As used in this section, HIV means human immunodeficiency virus.
(2) (a) Before July 1, 2027, the state department shall not restrict by prior authorization or step therapy requirements any prescription drug approved by the federal food and drug administration that is used for the treatment or prevention of HIV if a prescribing practitioner licensed pursuant to title 12 has determined the prescription drug to be medically necessary for the treatment or prevention of HIV for a member. Prescription drugs used for the treatment or prevention of HIV include protease inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, antivirals, integrase inhibitors, long-acting medications, and fusion inhibitors.
(b) Nothing in this subsection (2) prevents the state department from performing drug utilization review that may be necessary for patient safety or for ensuring the prescribed use is for a medically accepted indication, as required by section 1927 of the federal Social Security Act of 1935.
Source: L. 2023: Entire section added, (SB 23-189), ch. 69, p. 260, � 9, effective April 14. L. 2024: (2)(a) amended, (SB 24-176), ch. 152, p. 659, � 68, effective August 7; (2)(b) amended, (HB 24-1450), ch. 490, p. 3421, � 65, effective August 7.
25.5-5-515. Pharmacy reimbursement - vaccine administration to children - legislative declaration. (1) (a) The general assembly finds and declares that:
(I) Pharmacists are highly trained and educated, doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;
(II) Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;
(III) With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments; and
(IV) Convenient access to vaccines through a neighborhood pharmacy can help ensure that more children receive their childhood vaccinations according to federal recommended guidelines.
(b) Therefore, the general assembly declares that allowing reimbursement under the medical assistance program to a pharmacist or pharmacy that dispenses or administers childhood vaccinations is an important tool in ensuring the health of Colorado children through immunization.
(2) Pursuant to the requirements set forth in subsection (3) of this section, a pharmacist or pharmacy that dispenses or administers vaccinations to children under nineteen years of age pursuant to the federal centers for disease control and prevention's guidelines pertaining to the childhood immunization schedule may seek reimbursement for the dispensing or administration of vaccines under the medical assistance program either as a pharmacy benefit or as a medical benefit, as applicable.
(3) (a) To be eligible to receive reimbursement pursuant to subsection (2) of this section for administering vaccines to children, a pharmacy or pharmacist must be enrolled in good standing with the vaccines for children program administered by the department of public health and environment.
(b) Until the department of public health and environment determines a framework for participation by pharmacies and pharmacists in the vaccines for children program, nothing in this section requires the department of public health and environment to enroll pharmacies receiving reimbursement for the administration of vaccines through the medical assistance program as vaccines for children providers.
(c) As used in this subsection (3), vaccines for children program means the federal centers for disease control and prevention vaccines for children program administered by the department of public health and environment, or any successor program.
Source: L. 2023: Entire section added, (SB 23-162), ch. 148, p. 630, � 4, effective August 7.