Colo. Rev. Stat. § 10-16-103.6

Current through Acts effective through 7/1/2024 of the 2024 Legislative Session
Section 10-16-103.6 - Copayment-only prescription payment structures - required inclusion in health benefit plans - rules
(1)
(a) In addition to the requirements in section 10-16-103.4(2), for health benefit plans issued or renewed on or after January 1, 2023, each carrier that offers an individual or small group health benefit plan shall offer at least twenty-five percent of its health benefit plans on the exchange and at least twenty-five percent of its plans not on the exchange in each bronze, silver, gold, and platinum benefit level in each service area as copayment-only payment structures for all prescription drug cost tiers.
(b) For each copayment-only payment structure for prescription drugs:
(I) The copayment amount for the highest prescription drug cost tier must not be greater than one-twelfth of the health benefit plan's out-of-pocket maximum amount;
(II) The copayment amounts between the two highest prescription drug cost tiers must have a cost difference of at least ten percent;
(III) No more than fifty percent of the drugs on the prescription drug formulary used to treat a specific condition may be placed on the highest prescription drug cost tier; and
(IV) Each carrier shall use "Rx Copay" at the end of the marketing names for each copayment-only payment structure.
(2) The commissioner may promulgate rules to implement and enforce this section.

C.R.S. § 10-16-103.6

Added by 2022 Ch. 184, § 1, eff. 8/10/2022, app. to health benefit plans issued or renewed on or after 1/1/2023 ..
2022 Ch. 184, was passed without a safety clause. See Colo. Const. art. V, § 1(3).