Prescription Drug Benefit Information Transparency
Summary
HB1056 creates the “Prescription Drug Optimized Sourcing Transparency and Integrity Act,” aimed at self-insured employer health plans. The bill prohibits pharmacy benefit managers (PBMs) and health-care consultants from knowingly making false or misleading statements to employers or policyholders about the legality or safety of lawful prescription drug optimized sourcing programs, including pharmacy stewardship programs and certain personal-use importation arrangements authorized by federal law. It also states that these programs are recognized as cost-containment tools when they comply with federal law and the bill’s requirements.
The bill requires a PBM or health-care consultant, upon written request from a self-insured employer, to provide detailed claim-level cost information for each prescription drug dispensed under the plan, including total drug cost, member-paid amount, employer-paid amount, and drug-identifying details such as the National Drug Code, quantity, strength, and days’ supply. It further bars the PBM or consultant from withholding, editing, or redacting that information once provided. The bill expressly preserves a self-insured employer’s right to contract for lawful optimized sourcing programs and says it does not create a new insurance product, mandatory coverage, or a state funding obligation.
Impact
HB1056 would add a new section to Colorado insurance law governing PBMs and health-care consultants that serve self-insured employers, and it would make violations an unfair method of competition and an unfair or deceptive act or practice under the state’s insurance code. The bill also directs the insurance commissioner to enforce the new requirements within existing appropriations. In practical terms, it would expand transparency obligations around prescription drug pricing and sourcing options for self-funded plans while affirmatively recognizing lawful drug importation and other optimized sourcing arrangements under state law, so long as they comply with federal law.
Sentiment
The bill’s stated purpose and introduced text reflect a pro-transparency, pro-cost-savings approach, with the sponsor framing optimized sourcing and pharmacy stewardship as tools to reduce plan costs without harming patient safety or continuity of care. However, the committee outcome suggests limited support in the House Health & Human Services Committee: the bill was amended, failed to advance to Appropriations, and was ultimately postponed indefinitely. That pattern indicates that while the policy concept had some support, it did not secure enough backing to continue through the process.
Contention
The main points of contention appear to be whether the state should explicitly endorse and regulate prescription drug optimized sourcing and importation programs, and whether PBMs and consultants should be compelled to disclose detailed claim-level cost data to self-insured employers. Supporters likely viewed the bill as a transparency and cost-containment measure that protects employer purchasers from misinformation, while opponents may have been concerned about the legality, safety, administrative burden, or market effects of such sourcing programs and disclosure mandates. The committee vote history shows the bill was not broadly embraced, with a strong vote against referral to Appropriations and eventual indefinite postponement.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.