Colorado 2021 Regular Session Status: Enacted 1 R cosponsors

HB 21-1237 — Competitive Pharmacy Benefits Manager Marketplace

Last action — Governor Signed

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced March 22, 2021. Enacted.

Prognosis

Likely to advance 78% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 4 sponsors

    4 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (1 R).

  • Cleared a recorded vote

    Passed 2 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

The department of personnel (department) is required to contract for the services of a pharmacy benefit manager (PBM) for group benefit plans provided pursuant to the "State Employees Group Benefits Act" (state employee group benefits plans) and to procure a technology platform with the required capabilities for conducting a PBM reverse auction and the related services of a technology platform operator.The department is required to repurpose the technology platform used to conduct the reverse auction over the duration of the PBM services contract to perform reviews of all invoiced PBM prescription drug claims, and to identify all deviations from the specific terms of the PBM services contract. The department is required to reconcile the electronically adjudicated pharmacy claims with PBM invoices to ensure that state payments do not exceed the terms specified in any PBM services contract.Each PBM reverse auction is required to be completed and the PBM services contract awarded to the winning PBM within a specified timeline.The department may perform a market check for providing PBM services during the term of the current PBM services contract to ensure continuing competitiveness of incumbent prescription drug pricing over the life of a PBM services contract.To ensure that the department does not incur additional expenditures associated with the requirements of the act, the department is required to implement a no-pay option that obligates the winning PBM to pay the cost of the technology platform and related technology platform operator services by assessing a per-prescription fee and requiring the PBM to pay these fees to the technology operator over the duration of the PBM services contract.The act allows other health plans to use the processes and procedures established in the act individually, collectively, or as a joint purchasing group with the state employee group benefits plans.After completion of the first state employees group benefits plans PBM reverse auction, self-funded private sector employer or multi-employer health plans have the option to participate in a joint purchasing pool with state employees for conduct of subsequent PBM reverse auctions.The state employees group benefits plans and any self-funded public or private sector health plans that opt to participate with the state employees group benefits plans in a joint PBM reverse auction purchasing pool shall retain full autonomy over determination of their respective prescription drug formularies and pharmacy benefit designs and shall not be required to adopt a common prescription drug formulary or common prescription pharmacy benefit design.Any PBM providing services to the department or a self-funded public or private sector employee health plan is required to provide the department and the plan access to complete pharmacy claims data necessary to conduct the reverse auction and carry out their administrative and management duties.The department may elect to vacate the outcome of a PBM reverse auction if the lowest cost bid is not less than the projected cost trend for the incumbent PBM contract as verified by the department.(Note: This summary applies to this bill as enacted.)

Bill Text

What changed in the latest version

354 added · 288 removed

Plain-language change summary

The bill has undergone changes where specific language related to legislative sponsorship and bill summaries has been added or removed. Notably, the new version now includes a statement indicating that the summary applies to the bill as introduced and may not reflect future amendments. This matters because it clarifies the context of the summary, helping readers understand that changes could occur as the bill progresses.

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Latest
First Regular Session Seventy-third General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO.
First Regular Session Seventy-third General Assembly STATE OF COLORADO REENGROSSED This Version Includes All Amendments Adopted in the House of Introduction LLS NO.
21-0210.01 Jason Gelender x4330 HOUSE BILL 21-1237 HOUSE SPONSORSHIP LontineandRich, Amabile,Bradfield,Caraveo,Cutter,Kennedy,MichaelsonJenet,Ortiz, Ricks, Roberts, Will, Young SENATE SPONSORSHIP Kirkmeyer and Moreno, House Committees Senate Committees Health & Insurance A BILL FOR AN ACT C ONCERNINGTHECREATIONOFACOMPETITIVEPHARMACYBENEFITS MANAGER MARKETPLACE .
21-0210.01 Jason Gelender x4330 HOUSE BILL 21-1237 HOUSE SPONSORSHIP Lontine and Rich, Amabile, Bradfield, Caraveo, Cutter, Kennedy, Michaelson Jenet, Ortiz, Ricks, Roberts, Will, Young, Bernett, Bird, Boesenecker, Duran, Esgar, Exum, Gray, Hooton, Jackson, McCluskie, McCormick, Mullica, Snyder, Titone, Valdez D., Weissman SENATE SPONSORSHIP Kirkmeyer and Moreno, House Committees Senate Committees Health & Insurance A BILL FOR AN ACT C ONCERNINGTHECREATIONOFACOMPETITIVEPHARMACYBENEFITS MANAGER MARKETPLACE .
This summary applies to this bill as introduced and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.) The department of personnel (department) is required to contract for the services of a pharmacybenefit manager (PBM) for group benefit plans provided pursuant to the "State Employees Group Benefits Act" (state employee group benefits plans) and to procure a technology platform with the required capabilities for conducting a PBM reverse i 1 auction and the related services of a technology platform operator.
This summary applies to this bill as introduced and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill e n passes third reading in the house of introduction, a bill summary that m 1 applies to the reengrossed version of this bill will be available at E n 0 U U , http://leg.colorado.gov.) O i y H a a The department of personnel (department) is required to contract R M r for the services of a pharmacybenefit manager (PBM) for group benefit 3 plans provided pursuant to the "State Employees Group Benefits Act" (state employee group benefits plans) and to procure a technology platform with the required capabilities for conducting a PBM reverse i a 2 auction and the related services of a technology platform operator.
a 0 S R , O n 3 Shading denotes HOUSE amendment.
E e 2 U d 0 O 2 i Shading denotes HOUSE amendment.
H 2 r Capital letters or bold & italic numbers indicate new material to be added to existing sdatute.
H d p Capital letters or bold & italic numbers indicate new material to be added to existing statude.
e m A The department is required to repurpose the technology platform usedtoconductthereverseauctionoverthedurationofthePBMservices contracttoperformreviewsofallinvoicedPBMprescriptiondrugclaims, andtoidentifyalldeviationsfromthespecifictermsof thePBMservices contract.
e A The department is required to repurpose the technology platform usedtoconductthereverseauctionoverthedurationofthePBMservices contracttoperformreviewsofallinvoicedPBMprescriptiondrugclaims, andtoidentifyalldeviationsfromthespecifictermsof thePBMservices contract.
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Amendments

1 amendment

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Action History

  1. Governor Signed

  2. Signed by the President of the Senate

  3. Sent to the Governor

  4. Signed by the Speaker of the House

  5. Senate Third Reading Passed - No Amendments

  6. Senate Second Reading Passed - No Amendments

  7. Senate Committee on Health & Human Services Refer Unamended - Consent Calendar to Senate Committee of the Whole

  8. Introduced In Senate - Assigned to Health & Human Services

  9. House Third Reading Passed - No Amendments

  10. House Second Reading Passed with Amendments - Committee

  11. House Second Reading Laid Over Daily - No Amendments

  12. House Committee on Health & Insurance Refer Amended to House Committee of the Whole

  13. Introduced In House - Assigned to Health & Insurance

Sponsors

  • Susan Lontine · Primary
  • Janice Rich · Primary
  • Barbara Kirkmeyer · Primary
  • Dominick Moreno · Primary

Sponsorship breakdown

Export CSV (upgrade) →

4 sponsors · 0 co-sponsors · 97 not signed on · 2 voted No

Sponsors (4)

Co-sponsors (0)

None.

Not signed on (97)

97 members have not signed on to this bill.

Show all 97 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

BILL

Passed 27 Yea · 7 Nay · 1 Other
Party YeaNayPresentNot Voting
Democrat 7001
Unaffiliated 16700
Republican 4000
Total 27701
% of votes cast 77%20%0%3%
How each member voted (35)
Member Party Vote
Buckner — Yea
Cooke — Nay
Coram — Yea
Donovan — Yea
Fenberg — Yea
Fields — Yea
Gardner — Nay
Ginal — Yea
Hansen — Yea
Hisey — Yea
Holbert — Nay
Lee — Yea
Lundeen — Nay
Moreno — Yea
Pettersen — Yea
Priola — Yea
Rankin — Yea
Scott — Yea
Smallwood — Nay
Sonnenberg — Nay
Woodward — Nay
Zenzinger — Yea
Jaquez Lewis — Yea
Chris Kolker Democrat Yea
James Coleman Democrat Yea
Jeff Bridges Democrat Yea
Jessie Danielson Democrat Yea
Julie Gonzales Democrat Yea
Lorena Garcia Democrat Not Voting
Robert Rodriguez Democrat Yea
Tammy Story Democrat Yea
Barbara Kirkmeyer Republican Yea
Cleave Simpson Republican Yea
Larry Liston Republican Yea
Ty Winter Republican Yea

Official roll call →

BILL

Passed 52 Yea · 11 Nay · 2 Other
Party YeaNayPresentNot Voting
Unaffiliated 24901
Democrat 22001
Republican 6200
Total 521102
% of votes cast 80%17%0%3%
How each member voted (65)
Member Party Vote
Holtorf — Nay
Hooton — Yea
Larson — Nay
Lontine — Yea
Lynch — Yea
McKean — Nay
McLachlan — Yea
Neville — Nay
Ortiz — Yea
Pico — Not Voting
Ransom — Nay
Sandridge — Nay
Tipper — Yea
Will — Nay
Young — Yea
Garnett — Yea
Bernett — Yea
Bird — Yea
Bockenfeld — Yea
Caraveo — Yea
Carver — Yea
Esgar — Yea
Geitner — Nay
Gonzales-Gutierrez — Yea
Gray — Yea
Hanks — Nay
Herod — Yea
Adrienne Benavidez — Yea
Michaelson Jenet — Yea
Valdez D. — Yea
Van Beber — Yea
Van Winkle — Yea
Williams D. — Yea
deGruy Kennedy — Yea
Alex Valdez Democrat Not Voting
Andrew Boesenecker Democrat Yea
Brianna Titone Democrat Yea
Cathy Kipp Democrat Yea
Dylan Roberts Democrat Yea
Emily Sirota Democrat Yea
Iman Jodeh Democrat Yea
Jamie Jackson Democrat Yea
Jennifer Bacon Democrat Yea
Judy Amabile Democrat Yea
Julie McCluskie Democrat Yea
Karen McCormick Democrat Yea
Kyle Mullica Democrat Yea
Lindsey Daugherty Democrat Yea
Lisa Cutter Democrat Yea
Marc Snyder Democrat Yea
Meg Froelich Democrat Yea
Mike Weissman Democrat Yea
Monica Duran Democrat Yea
Naquetta Ricks Democrat Yea
Steven Woodrow Democrat Yea
Tom Sullivan Democrat Yea
Tony Exum Democrat Yea
Dan Woog Republican Nay
Janice Rich Republican Yea
Marc Catlin Republican Yea
Mark Baisley Republican Yea
Mary Bradfield Republican Yea
Matt Soper Republican Yea
Rod Pelton Republican Yea
Stephanie Luck Republican Nay

Official roll call →

Subjects

healthcare health-insurance technology
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 21-1237 do?
The department of personnel (department) is required to contract for the services of a pharmacy benefit manager (PBM) for group benefit plans provided pursuant to the "State Employees Group Benefits Act" (state employee group benefits plans) and to procure a technology platform with the required capabilities for conducting a PBM reverse auction and the related services of a technology platform operator.The department is required to repurpose the technology platform used to conduct the reverse auction over the duration of the PBM services contract to perform reviews of all invoiced PBM prescription drug claims, and to identify all deviations from the specific terms of the PBM services contract. The department is required to reconcile the electronically adjudicated pharmacy claims with PBM invoices to ensure that state payments do not exceed the terms specified in any PBM services contract.Each PBM reverse auction is required to be completed and the PBM services contract awarded to the winning PBM within a specified timeline.The department may perform a market check for providing PBM services during the term of the current PBM services contract to ensure continuing competitiveness of incumbent prescription drug pricing over the life of a PBM services contract.To ensure that the department does not incur additional expenditures associated with the requirements of the act, the department is required to implement a no-pay option that obligates the winning PBM to pay the cost of the technology platform and related technology platform operator services by assessing a per-prescription fee and requiring the PBM to pay these fees to the technology operator over the duration of the PBM services contract.The act allows other health plans to use the processes and procedures established in the act individually, collectively, or as a joint purchasing group with the state employee group benefits plans.After completion of the first state employees group benefits plans PBM reverse auction, self-funded private sector employer or multi-employer health plans have the option to participate in a joint purchasing pool with state employees for conduct of subsequent PBM reverse auctions.The state employees group benefits plans and any self-funded public or private sector health plans that opt to participate with the state employees group benefits plans in a joint PBM reverse auction purchasing pool shall retain full autonomy over determination of their respective prescription drug formularies and pharmacy benefit designs and shall not be required to adopt a common prescription drug formulary or common prescription pharmacy benefit design.Any PBM providing services to the department or a self-funded public or private sector employee health plan is required to provide the department and the plan access to complete pharmacy claims data necessary to conduct the reverse auction and carry out their administrative and management duties.The department may elect to vacate the outcome of a PBM reverse auction if the lowest cost bid is not less than the projected cost trend for the incumbent PBM contract as verified by the department.(Note: This summary applies to this bill as enacted.)
Who sponsors HB 21-1237?
HB 21-1237 is sponsored by Susan Lontine, Janice Rich, Barbara Kirkmeyer (Republican), and Dominick Moreno.
What is the current status of HB 21-1237?
This bill has been enacted into law. Introduced March 22, 2021. Enacted.
Where can I track HB 21-1237?
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