Rep. Katie Stewart

Beginning January 1, 2027, the act: Allows a pharmacy benefit manager (PBM) to earn income derived from the assessment of a flat-dollar service fee for the provision of a prescription drug; Prohibits a PBM from earning income based on the price or cost of a prescription drug; Prohibits a PBM from designing a formulary to favor a certain branded pharmaceutical or biologic; Requires a PBM to be reimbursed by a health benefit plan for lowering the plan's prescription drug spending over a given period of time and for the direct services the PBM provides to the plan; Sets the amount that a PBM shall reimburse an unaffiliated pharmacy or a PBM-affiliated retail, mail order, or specialty pharmacy for a prescription drug; and Requires a contract between a PBM and a health benefit plan to contain a provision where the PBM discloses prescription drug cost information to the health benefit plan and a provision authorizing the health benefit plan to execute an audit to validate compliance with the contract.(Note: This summary applies to this bill as enacted.)

The act changes the term "epinephrine auto-injector" to "emergency-use epinephrine" in order to encompass alternatives to injecting epinephrine as a means to treat anaphylaxis in school settings. (Note: This summary applies to this bill as enacted.)

The act requires that, for health insurance policies providing maternity coverage, policies issued or renewed on or after January 1, 2027, must include prenatal care coverage without cost sharing for up to 3 office visits. (Note: This summary applies to this bill as enacted.)

For ground ambulance services (ambulance services), the act: Allows a political subdivision or an ambulance service providing ambulance services on behalf of the political subdivision to submit to the division of insurance (division) the established rates for the ambulance services, if the rates meet specified conditions; Requires the division to publish reimbursement rates on the division's public-facing website; Establishes reimbursement rates for ambulance services that are out of network; and Prohibits an out-of-network ambulance service from billing an individual covered under a health insurance coverage plan (covered person) any outstanding balance for a covered service not paid for by an insurance carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. If a covered person makes a payment for an out-of-network ambulance service, the payment must be applied to the covered person's in-network deductibles and in-network out-of-pocket maximum amounts. For the 2025-26 state fiscal year, $38,149 is appropriated from the division of insurance cash fund to the department of regulatory agencies for use by the division to implement the act. VETOED by Governor 5/29/2025(Note: This summary applies to this bill as enacted.)

Section 1 of the act creates the prescribed fire claims cash fund (fund) in the state treasury and requires the state treasurer to transfer $250,000 from the general fund to the fund on July 1, 2025. Subject to annual appropriation by the general assembly, the division of fire prevention and control (division) shall expend money from the fund to pay claims for damages related to prescribed burns that are certified by the division in accordance with new guidelines as specified in the act and as adopted by the director of the division. The division shall authorize a payment in the amount certified in a claim; except that the maximum payment that the division may authorize for a singular burn is equal to the greater of $20,000 or 10% of the amount of money in the fund at the time the claim is filed. Subject to annual appropriation by the general assembly of money for the division to administer the fund, the division shall certify a claim that meets the following guidelines: The claim demonstrates, in sufficient detail, the costs or damages that resulted from the prescribed burn; The prescribed burn that resulted in the costs or damages was conducted in full compliance with statutory and regulatory requirements for prescribed burning; Before conducting the prescribed burn, the certified prescribed burn manager registered the written prescription plan for the prescribed burn with the division and paid an administrative fee; and No more than 60 days have passed between the completion of the prescribed burn and the date upon which costs and damages were incurred. The act authorizes the director of the division to adopt rules and guidelines for the implementation and administration of the program and permits the division to contract with a third party to administer, certify, and pay the claims. The act also requires a claimant who accepts a payment that covers the full amount certified in the claim to waive all future claims related to the prescribed burn against the certified prescribed burn manager that conducted the burn; any organization, entity, or individual with whom the certified prescribed burn manager worked to conduct the burn; any individual or entity that provided funding for the burn; and any landowner on whose behalf the burn was conducted. Sections 2 and 3 expand the definition of a "certified burner" in the state to include an individual who has not completed the Colorado division's training and certification program but who meets reciprocity requirements and possesses a valid Colorado certification number. An individual seeking certification through reciprocity may receive a certification number from the division by: Applying for certification to the division, according to the rules and standards of the division, including the payment of any associated fee; and Submitting evidence to the division, according to the rules and standards of the division, that the individual holds a valid certification from a state government or other entity. The required rules and standards adopted by the director of the division, in consultation with the Colorado state forest service, pertaining to the qualification for and the terms and durations of certification, are required to include certification through reciprocity. Section 4 adds pretax costs associated with the implementation of an approved program or project to mitigate the effects of extreme weather, wildfires, climate change, or other hazards to the definition of Colorado energy impact costs. For the 2025-26 fiscal year: $250,000 is appropriated from the fund to the department of public safety for use by the division for prescribed fire claims; and $153,025 is appropriated from the general fund to the department of public safety for implementation of the act.(Note: This summary applies to this bill as enacted.)

The act allows enrolled members of the Southern Ute Indian Tribe and enrolled members of the Ute Mountain Ute Tribe to enter state parks without having to pay an entrance fee. By June 1, 2026, the division of parks and wildlife (division) in the department of natural resources (department) shall build on existing efforts to conduct outreach to and engagement with the Southern Ute Indian Tribe, the Ute Mountain Ute Tribe, other tribal governments, American Indian communities, and Indigenous communities about opportunities related to state parks that are managed by the division. In January 2026 and January 2027, the department shall include, as part of its presentation during its "SMART Act" hearing, information concerning the division's outreach and engagement about opportunities related to state parks. (Note: This summary applies to this bill as enacted.)

The act requires the state board of education (board) to adopt high school health education standards regarding drug overdose risks, identification of a drug overdose event, and drug overdose prevention and response. The act authorizes the board to seek, accept, and expend gifts, grants, or donations for the purpose of adopting these standards. The board must adopt the standards on or before July 1, 2028, if, the board receives by July 1, 2026, $20,000 from gifts, grants, or donations to adopt the standards. If sufficient money is not received, the board is required to adopt the standards on or before July 1, 2032, pursuant to the general standards schedule. Under current law, a school district, the state charter school institute (institute), or the governing board of a nonpublic school may adopt and implement a policy allowing an employee or agent of the school to furnish an opioid antagonist to any individual, including a student, but only if the student has received appropriate school-sponsored training. The act repeals the required condition that a student must receive appropriate school-sponsored training. The act authorizes a school district, the institute, a public school, or a nonpublic school to seek, accept, and expend gifts, grants, or donations for purposes related to acquiring, maintaining, and providing training for administering opioid antagonists. (Note: This summary applies to this bill as enacted.)

The act allows a health-care provider to, under certain circumstances, adjust the dose or frequency of a chronic maintenance drug without needing prior authorization from an insurance carrier. (Note: This summary applies to this bill as enacted.)

The act makes changes to requirements for preventive care coverage by health insurers for breast cancer screening, including: Relocating in statute the high-risk breast cancer screening requirements; Defining and specifying criteria for the use of diagnostic breast examinations and supplemental breast examinations; and Clarifying that, in addition to regular breast cancer screening, diagnostic and supplemental breast examinations that are medically necessary and conducted within nationally recognized screening guidelines do not require cost sharing by the patient.(Note: This summary applies to this bill as enacted.)

Current Colorado laws do not always expressly provide whether the laws apply to the Southern Ute Indian Tribe or the Ute Mountain Ute Tribe (Tribes). The act creates a rule of construction that a law does not apply to the Tribes unless the law clearly and expressly states that the law applies to the Tribes. The act further clarifies that if the general assembly enacts a new law or materially amends an existing law that is silent as to its application to the Tribes or to tribally controlled entities; purports to apply statewide; or grants a governmental agency or entity civil, criminal, or regulatory authority, it is presumed that the law does not apply within the exterior boundaries of the reservations to the Tribes, including the Tribes' officials and employees acting in their official capacities, to a tribally controlled entity, or to Tribal lands. The act reinforces that these rules of construction do not: Preclude or limit the authority of the Tribes' governing bodies from requesting inclusion in legislation pending before the general assembly; Abrogate the sovereign immunity of the state or the Tribes; or Affect the rights of the state, the Tribes, or other persons to pursue legal remedies that may be available to contest the application of laws passed by the general assembly.(Note: This summary applies to this bill as enacted.)