CO| Colorado’s new Regulation 4-2-104, adopted by the Colorado Division of Insurances, which requires health insurance carriers and pharmacy benefit managers (PBMs) to disclose prescription drug contract terms to policyholders for group health benefit plans starting in 2025. The regulation establishes clear disclosure requirements, compliance attestations, and possible exemptions for certain carriers, with enforcement provisions for noncompliance.
Key Points:
- Carriers and PBMs must provide detailed prescription drug contract terms to policyholders or their representatives at least 90 days before contract renewal, beginning with the 2026 plan year.
- Annual compliance attestation forms, including copies of disclosures, must be submitted through the SERFF system by June 1 each year.
- Carriers may be exempt from disclosure requirements if they meet specific criteria, such as operating their own pharmacies and providing most services through a single medical group; otherwise, noncompliance may result in penalties or license actions.