Archive #64526

Metadata

Bill Number: SB26-167
HTTP Status: 200
Valid JSON: Valid
Archived At: 2026-05-20 14:45:10 MDT
Created At: 2026-05-20 14:45:10 MDT

Parsed JSON

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          "vote": "N",
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      "vote_date_time": "05/06/2026 12:17:18 PM"
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  "active": "T",
  "origin": "Senate",
  "lls_num": "26-0939",
  "session": "2026A",
  "subject": [
    "Health Care & Health Insurance"
  ],
  "bill_num": "SB26-167",
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  ],
  "committees": [
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      "id": "H_HHS_2026A",
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    },
    {
      "id": "S_APP_2026A",
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  ],
  "long_title": "Concerning a covered person's contribution under a health benefit plan based on out-of-pocket expenses attributable to the purchase of prescription drugs.",
  "bill_status": "Enroll into an Act",
  "short_title": "Prescription Drug Out-of-Pocket Expense Credit",
  "bill_summary": "<html><body><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strike>Subject to certain exceptions</strike> <i>Beginning on January 1, 2028,</i> the bill requires a carrier of an individual or group health benefit plan in Colorado (plan), when calculating a covered person's overall contribution to an out-of-pocket maximum or cost-sharing requirement under the plan (contribution), to account for and credit to the covered person's contribution <i>(contribution credit)</i> an out-of-pocket expense that the covered person incurs by purchasing a prescription drug directly from a pharmacy <strike>, health-care provider,</strike> or direct-to-consumer platform <strike>(direct purchase of a prescription drug)</strike> . The carrier shall apply the <i>contribution</i> credit to the covered person's contribution <i>to the out-of-pocket maximum or cost-sharing requirement</i> that is applicable in the plan year in which the expense from the direct purchase of a prescription drug was incurred.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;To receive a contribution credit for an out-of-pocket expense that a covered person incurred because of a direct purchase of a prescription drug, the covered person must provide proof of payment <i>through documentation, such as an itemized receipt or pharmacy record, that is submitted</i> to the carrier <i>within 90 days after making the purchase</i> . <strike>If the covered person does not provide proof of payment, the carrier is prohibited from applying the contribution credit.</strike> </p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill <strike>also</strike> prohibits a carrier from applying the contribution credit in certain <strike>other</strike> instances. Specifically, the carrier shall not apply the contribution credit:<br/></p><p><ul><li>For an amount of the covered person's out-of-pocket expense from the direct purchase of a prescription drug that is greater than the amount the covered person would have incurred if they had obtained the same prescription drug in the same plan year from an in-network pharmacy and pursuant to the terms of their plan;</li><li> <i>If the covered person does not provide proof of payment;</i></li><li>If the covered person incurred the out-of-pocket expense by purchasing a prescription drug that is not covered under the formulary of the covered person's plan, unless <i>the carrier grants</i> an exception <strike>is granted</strike> ; or</li><li>If the covered person does not comply with the carrier's utilization management processes, including prior authorization and step therapy protocols required under the covered person's plan.</li></ul></p><p><br/><i>(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)</i><br/><br/><br/><i>(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)</i></p></body></html>",
  "progress_bar": [
    {
      "end": "F",
      "label": "Introduced",
      "position": 1
    },
    {
      "end": "F",
      "label": "Passed",
      "position": 2
    }
  ],
  "special_type": "",
  "bill_category": "Insurance",
  "allow_testimony": "F",
  "amendment_files": [
    {
      "url": "https://s3-us-west-2.amazonaws.com/leg.colorado.gov/2026A/amendments/C3743C6623CA5C6687258DE90067459A/SB167_L.001.pdf",
      "date": "04/30/2026 06:09:32 PM",
      "vote": "Passed*",
      "chamber": "Senate",
      "hearing": "SEN Health & Human Services",
      "url_html": "https://s3-us-west-2.amazonaws.com/leg.colorado.gov/2026A/amendments/C3743C6623CA5C6687258DE90067459A/SB167_L_001.html",
      "amendment": "L.001"
    }
  ],
  "full_bill_topic": "Prescription Drug Out-of-Pocket Expense Credit",
  "long_bill_files": [],
  "GHG_report_files": [],
  "preamended_files": [
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/167_S_HHS_01.pdf",
      "date": "05/01/2026",
      "label": "PA1",
      "url_html": "",
      "lastModified": "05/01/2026 09:51:00 AM",
      "label_detailed": "Senate Health & Human Services Preamend"
    }
  ],
  "bill_sub_category": "Health Insurance",
  "fiscal_note_files": [
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_00.pdf",
      "date": "04/30/2026",
      "label": "FN1",
      "url_html": "",
      "lastModified": "05/19/2026 09:48:11 AM",
      "label_detailed": "Initial Fiscal Note"
    },
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_r1.pdf",
      "date": "05/04/2026",
      "label": "FN2",
      "url_html": "",
      "lastModified": "05/04/2026 02:56:08 PM",
      "label_detailed": "First Revised Fiscal Note"
    }
  ],
  "is_budget_package": "No",
  "session_laws_files": "",
  "summarized_history": [
    {
      "date": "05/09/2026",
      "action": "House Third Reading Passed - No Amendments",
      "location": "House"
    },
    {
      "date": "05/08/2026",
      "action": "House Second Reading Special Order - Passed - No Amendments",
      "location": "House"
    },
    {
      "date": "05/08/2026",
      "action": "House Committee on Health & Human Services Refer Unamended to House Committee of the Whole",
      "location": "House"
    },
    {
      "date": "05/06/2026",
      "action": "Introduced In House - Assigned to Health & Human Services",
      "location": "House"
    },
    {
      "date": "05/06/2026",
      "action": "Senate Third Reading Passed - No Amendments",
      "location": "Senate"
    },
    {
      "date": "05/05/2026",
      "action": "Senate Second Reading Special Order - Passed with Amendments - Committee",
      "location": "Senate"
    },
    {
      "date": "05/05/2026",
      "action": "Senate Committee on Appropriations Refer Unamended to Senate Committee of the Whole",
      "location": "Senate"
    },
    {
      "date": "04/30/2026",
      "action": "Senate Committee on Health & Human Services Refer Amended to Appropriations",
      "location": "Senate"
    },
    {
      "date": "04/16/2026",
      "action": "Introduced In Senate - Assigned to Health & Human Services",
      "location": "Senate"
    }
  ],
  "research_note_files": [],
  "bill_sub_sub_category": "Health Care Coverage Cooperatives",
  "committee_report_files": [
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_S_HHS_001.pdf",
      "date": "04/30/2026",
      "label": "S_HHS_2026A",
      "url_html": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_S_HHS_001.html",
      "lastModified": "05/01/2026 10:30:49 AM"
    },
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_S_APP_001.pdf",
      "date": "05/05/2026",
      "label": "S_APP_2026A",
      "url_html": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_S_APP_001.html",
      "lastModified": "05/05/2026 11:00:58 AM"
    },
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_H_HHS_001.pdf",
      "date": "05/08/2026",
      "label": "H_HHS_2026A",
      "url_html": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB167_H_HHS_001.html",
      "lastModified": "05/08/2026 02:01:14 PM"
    }
  ],
  "demographic_note_files": [],
  "updated_bill_summary_files": [],
  "budget_staff_analysis_files": [
    {
      "url": "https://www.leg.state.co.us/CLICS/CLICS2026A/csl.nsf/0/E3D17D0454B226F687258DB9005AA91E/$File/SB0167_sen.pdf",
      "date": "05/04/2026",
      "label": "SA1",
      "url_html": "",
      "lastModified": "05/04/2026 11:50:16 AM",
      "label_detailed": "Senate Appropriation Analysis (1)"
    }
  ],
  "first_chamber_third_reading_date": "05/06/2026",
  "second_chamber_third_reading_date": "05/09/2026"
}

Raw Response

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out-of-pocket maximum or cost-sharing requirement under the plan (contribution), to account for and credit to the covered person's contribution <i>(contribution credit)</i> an out-of-pocket expense that the covered person incurs by purchasing a prescription drug directly from a pharmacy <strike>, health-care provider,</strike> or direct-to-consumer platform <strike>(direct purchase of a prescription drug)</strike> . The carrier shall apply the <i>contribution</i> credit to the covered person's contribution <i>to the out-of-pocket maximum or cost-sharing requirement</i> that is applicable in the plan year in which the expense from the direct purchase of a prescription drug was incurred.</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;To receive a contribution credit for an out-of-pocket expense that a covered person incurred because of a direct purchase of a prescription drug, the covered person must provide proof of payment <i>through documentation, such as an itemized receipt or pharmacy record, that is submitted</i> to the carrier <i>within 90 days after making the purchase</i> . <strike>If the covered person does not provide proof of payment, the carrier is prohibited from applying the contribution credit.</strike> </p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The bill <strike>also</strike> prohibits a carrier from applying the contribution credit in certain <strike>other</strike> instances. Specifically, the carrier shall not apply the contribution credit:<br/></p><p><ul><li>For an amount of the covered person's out-of-pocket expense from the direct purchase of a prescription drug that is greater than the amount the covered person would have incurred if they had obtained the same prescription drug in the same plan year from an in-network pharmacy and pursuant to the terms of their plan;</li><li> <i>If the covered person does not provide proof of payment;</i></li><li>If the covered person incurred the out-of-pocket expense by purchasing a prescription drug that is not covered under the formulary of the covered person's plan, unless <i>the carrier grants</i> an exception <strike>is granted</strike> ; or</li><li>If the covered person does not comply with the carrier's utilization management processes, including prior authorization and step therapy protocols required under the covered person's plan.</li></ul></p><p><br/><i>(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)</i><br/><br/><br/><i>(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)</i></p></body></html>","amendment_files":[{"chamber":"Senate","date":"04/30/2026 06:09:32 PM","amendment":"L.001","hearing":"SEN Health & Human Services","vote":"Passed*","url":"https://s3-us-west-2.amazonaws.com/leg.colorado.gov/2026A/amendments/C3743C6623CA5C6687258DE90067459A/SB167_L.001.pdf","url_html":"https://s3-us-west-2.amazonaws.com/leg.colorado.gov/2026A/amendments/C3743C6623CA5C6687258DE90067459A/SB167_L_001.html"}],"session_laws_files":"","votes":[{"vote_id":"933","chamber":"HOUSE","action":"Third Reading","date":"05/09/2026",
"vote_date_time":"05/09/2026 12:30:59 PM","lay_over_date":"",

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