Section 12-280-140 - Emergency prescription insulin supply - eligibility - record keeping(1)(a) Effective January 1, 2022, an individual who meets the requirements of subsection (2) of this section may receive one emergency thirty-day supply of prescription insulin within a twelve-month period. The pharmacy may charge the individual an amount not to exceed thirty-five dollars for the thirty-day supply.(b) By January 1, 2022, each manufacturer shall establish procedures to make insulin available in accordance with this section to eligible individuals who need access to an emergency prescription insulin supply.(2) To be eligible for an emergency prescription insulin supply, an individual must: (a) Have a valid prescription for insulin or be eligible for an emergency supply as provided in section 12-280-125.5;(b) Have less than a seven-day supply of insulin available;(c) Be required to pay more than one hundred dollars out of pocket each month for the individual's insulin; and(d) Be a resident of Colorado.(3)(a) The division of insurance shall create and make available to the public an application form for individuals seeking an emergency prescription insulin supply pursuant to this section.(b) At a minimum, the application form must require the individual to show proof that the individual meets the requirements of subsection (2) of this section.(c) Each pharmacy in the state shall make the application form available at the pharmacy.(4)(a) Upon receipt of an individual's completed application form demonstrating that the individual is eligible pursuant to subsection (2) of this section and the individual's proof of residency, a pharmacist shall dispense the prescribed insulin in an amount that will provide the individual with a thirty-day supply.(b) If the individual is under eighteen years of age, the individual's parent or legal guardian may provide the pharmacist with proof of residency.(5) Each pharmacy shall keep the application form for each individual who receives an emergency prescription insulin supply pursuant to this section for two years following the date on which the insulin was dispensed.(6)(a) Except as provided in subsection (6)(d) of this section, unless the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin dispensed in the amount dispensed through the program, the pharmacy may submit to the manufacturer of the dispensed insulin, directly or through the manufacturer's delegated representative, subcontractor, or other vendor, an electronic claim for payment that is made in accordance with the National Council for Prescription Drug Programs' standards for electronic claims processing.(b) By January 1, 2022, each manufacturer shall develop a process for a pharmacy to submit an electronic claim for reimbursement as provided in subsection (6)(a) of this section.(c) If the pharmacy submits an electronic claim to the manufacturer pursuant to subsection (6)(a) of this section, the manufacturer or the manufacturer's delegated representative, subcontractor, or other vendor shall, within thirty days after receipt of the claim, either: (I) Reimburse the pharmacy in an amount that covers the pharmacy's wholesale acquisition cost for the insulin dispensed pursuant to this section; or(II) Send the pharmacy a replacement supply of the same insulin in an amount equal to or greater than the amount that covers the pharmacy's wholesale acquisition cost for the insulin dispensed pursuant to this section.(d) A pharmacy shall not submit a claim for payment for insulin with a wholesale acquisition cost of eight dollars or less per milliliter, adjusted annually based on the annual percentage change in the consumer price index.(7) The division of insurance and the department of health care policy and financing shall promote the availability of the emergency prescription insulin supply to Coloradans. The promotional material must include information about each manufacturer's consumer insulin programs. Each agency may seek and accept gifts, grants, and donations to fulfill the requirements of this subsection (7).(8) A manufacturer's reimbursement pursuant to subsection (6)(b) of this section is not a kickback.(9) A manufacturer that fails to comply with the requirements of this section is subject to a fine of ten thousand dollars for each month of noncompliance.Added by 2021 Ch. 437, § 3, eff. 9/7/2021. For the legislative declaration in HB 21-1307, see section 1 of chapter 437, Session Laws of Colorado 2021.