CO| Regulation 4-2-103, concerning Transparency in Coverage Reporting Requirements, aims to establish guidelines for carriers and pharmacy benefit managers (PBMs) to submit price transparency files and prescription drug data collection reports. The regulation applies to all carriers and plans subject to the federal Transparency in Coverage rule and the Consolidated Appropriations Act of 2021. Effective April 14, 2025.
Key points:
- Carriers must submit three JSON files biannually starting July 1, 2025, containing information on in-network rates, out-of-network allowed amounts, and a table of contents.
- Beginning July 1, 2025, carriers and PBMs must annually submit prescription drug and healthcare spending data, known as the RxDC report.
- The submitted files must be filtered to include only Colorado-specific data and providers with 20 or more services performed in the last year.
- The regulation outlines confidentiality procedures and enforcement measures for non-compliance.