C.R.S. Section 25.5-1-134
Prescription benefits

  • department and pharmacy benefit manager
  • contracts
  • audit
  • rules

(1)

For contracts between a pharmacy benefit manager and the state department or one of its affiliated managed care organizations offering a prescription benefit plan that is issued or renewed on or after January 1, 2025, the amount charged by the pharmacy benefit manager to the state department or managed care organization for a prescription drug dispensed to an enrollee in the program of medical assistance created pursuant to section 25.5-4-104 must be equal to or less than the amount paid by the pharmacy benefit manager to a medicaid pharmacy for the prescription drug dispensed to the enrollee.

(2)

The state board shall promulgate rules to implement this section, including rules guiding an audit of managed care or fee-for-service claims, to ensure that there is no violation of subsection (1) of this section.

Source: Section 25.5-1-134 — Prescription benefits - department and pharmacy benefit manager - contracts - audit - rules, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-25.­5.­pdf (accessed Oct. 20, 2023).

25.5‑1‑101
Short title 25.5‑1‑102
Legislative declaration 25.5‑1‑103
Definitions 25.5‑1‑104
Department of health care policy and financing created - executive director - powers, duties, and functions - report 25.5‑1‑105
Transfer of functions 25.5‑1‑105.5
Chief medical officer - qualifications 25.5‑1‑107
Final agency action - administrative law judge - authority of executive director 25.5‑1‑108
Executive director - rules 25.5‑1‑109
Department of health care policy and financing cash fund 25.5‑1‑109.5
Clinical standards - development 25.5‑1‑114
Grants-in-aid - county supervision 25.5‑1‑114.5
Medicaid fraud detection - request for information 25.5‑1‑115
Locating violators - recoveries 25.5‑1‑115.5
Medical assistance fraud - report 25.5‑1‑116
Records confidential - authorization to obtain records of assets - release of location information to law enforcement agencies - outstanding felony arrest warrants 25.5‑1‑117
County departments - district departments 25.5‑1‑118
Duties of county departments 25.5‑1‑119
County staff 25.5‑1‑120
Appropriations 25.5‑1‑121
County expenditures - advancements - procedures 25.5‑1‑122
County appropriation increases - limitations 25.5‑1‑123
Medical homes for children - legislative declaration - duties of the department 25.5‑1‑124
Early intervention payment system - participation by state department - rules - definitions 25.5‑1‑126
Discounted prices for durable medical equipment and supplies 25.5‑1‑127
Third-party benefit denials information 25.5‑1‑128
Provider payments - compliance with state fiscal requirements - definitions - rules 25.5‑1‑129
State department proposal - state option for health-care coverage - report to general assembly - waiver authorization - legislative declaration 25.5‑1‑130
Improving access to behavioral health services for individuals at risk of entering the criminal or juvenile justice system - duties of the state department 25.5‑1‑131
Insurance ombudsman - consumer advocate - duties 25.5‑1‑132
Report of medicaid reimbursement rates paid to community mental health center providers and independent providers - definition 25.5‑1‑133
Access to behavioral health services for individuals under twenty-one years of age - rules - report - repeal 25.5‑1‑134
Prescription benefits - department and pharmacy benefit manager - contracts - audit - rules 25.5‑1‑201
Programs to be administered by the department of health care policy and financing 25.5‑1‑203
Prescription drug information and technical assistance program - expansion 25.5‑1‑204
Advisory committee to oversee the all-payer health claims database - creation - members - duties - legislative declaration - rules - report 25.5‑1‑204.5
All-payer health claims database scholarship grant program - creation - definitions 25.5‑1‑204.7
All-payer health claims database - creation of tool for review of data included in the database - definitions 25.5‑1‑205
Providing for the efficient provision of health care through state-supervised cooperative action - rules 25.5‑1‑206
School-based substance abuse prevention and intervention program - creation - reporting - legislative declaration - definitions 25.5‑1‑207
Rural provider access and affordability stimulus grant program - advisory committee - fund - reporting - rules - definitions - repeal 25.5‑1‑301
Medical services board - creation 25.5‑1‑302
Medical services board - organization 25.5‑1‑303
Powers and duties of the board - scope of authority - rules 25.5‑1‑601
Legislative declaration 25.5‑1‑602
Commission created - composition - terms of office 25.5‑1‑603
Duties of commission - reporting 25.5‑1‑701
Definitions 25.5‑1‑702
Hospitals - public community meeting requirement - rules 25.5‑1‑703
Hospitals - community health needs assessments - community benefit implementation plans - reports - rules 25.5‑1‑704
Hospital community investment compliance - rules 25.5‑1‑801
Definitions 25.5‑1‑802
Medicaid transportation services - safety and oversight - rules 25.5‑1‑901
Legislative declaration 25.5‑1‑902
Definitions 25.5‑1‑903
Failure to comply with hospital price transparency laws - prohibiting collection of debt - penalty 25.5‑1‑904
Transparency - hospitals - standard charges - shoppable services - enforcement 25.5‑1‑1001
Hospital collaborative agreements - review of proposed collaborative agreements - immunity - legislative declaration - definitions - rules
Green check means up to date. Up to date

Current through Fall 2024

§ 25.5-1-134’s source at colorado​.gov