Preserving Access to Rural Independent Pharmacies
House Bill 25-1222 is aimed at preserving access to health care in rural Colorado by supporting rural independent pharmacies. The bill makes a legislative declaration that these pharmacies are essential to rural and vulnerable populations and that closures are being driven in part by low reimbursement from pharmacy benefit managers (PBMs). It defines “rural independent pharmacy” and then creates several protections and reimbursement rules for those pharmacies under Colorado insurance and pharmacy law.
The bill prohibits PBMs from blocking rural independent pharmacies from using private couriers or delivery services to deliver prescriptions, or from requiring PBM approval to do so. Beginning January 1, 2026, PBMs must reimburse rural independent pharmacies at no less than the national average drug acquisition cost plus a dispensing fee; if that cost benchmark is unavailable, reimbursement cannot fall below wholesale acquisition cost. The bill also requires the dispensing fee to increase by 1% annually starting January 1, 2027. In addition, it strengthens audit protections by requiring appeal procedures, limiting recoupment for clerical errors absent actual financial harm, and adding extra notice and service requirements before large recoupments or penalties are imposed on rural independent pharmacies.
The bill also makes a narrower licensing change: a rural independent pharmacy does not have to be under the direct charge of a pharmacist if the initial interpretation and final evaluation of the prescription are done by a Colorado-licensed pharmacist in person or remotely. This change appears intended to give rural pharmacies more operational flexibility, especially where staffing is limited. The bill applies these changes across the insurance and pharmacy statutes it amends, including provisions governing PBM conduct, pharmacy audits, and prescription drug outlet definitions.
Overall, the sentiment reflected in the bill’s legislative history is strongly supportive. Committee and floor votes were overwhelmingly favorable, with several unanimous committee votes and only a small number of dissenting votes on final passage and concurrence. The bill was also recommended for the consent calendar in the Senate, suggesting broad bipartisan agreement that rural pharmacy access is a priority.
The main point of contention appears to be the regulatory and financial burden placed on PBMs and health plans, particularly the mandated reimbursement floor and the added audit restrictions. Supporters frame the bill as necessary to prevent rural pharmacy closures and preserve access to medications and related clinical services, while any opposition likely centers on cost impacts, administrative requirements, and the potential for reduced flexibility in PBM contracting and audit practices.
The bill amends Colorado law in Title 10 and Title 12 to create a formal definition of rural independent pharmacy, restrict PBM practices affecting those pharmacies, set minimum reimbursement standards, and add audit notice and appeal protections. It also modifies pharmacist supervision rules for rural independent pharmacies, giving them more flexibility in how prescriptions are reviewed and finalized. These changes directly affect PBMs, carriers, rural independent pharmacies, pharmacists, and health plans that manage prescription drug benefits.
The overall sentiment appears highly favorable and bipartisan. Committee votes were unanimous on amendments and advancement, and floor votes were overwhelmingly in favor in both chambers, with only a few dissenting votes. The bill’s consent-calendar treatment in the Senate further suggests that lawmakers broadly viewed it as a practical response to rural access and pharmacy closure concerns.
The likely area of disagreement is the bill’s impact on PBMs and insurers, especially the requirement to reimburse rural independent pharmacies at or above national acquisition-cost benchmarks plus a dispensing fee, with annual fee increases. PBMs may also object to the limits on audit recoupments and the added notice requirements before penalties are collected. Supporters, by contrast, emphasize that these measures are needed to keep rural pharmacies open and preserve access to medications, delivery, and other clinical services in underserved communities.