Colorado law requires plans to cover eligible pharmacist services

Health plans must cover eligible health-care services provided by pharmacists. This applies to health benefit plans that provide hospital, surgical, or medical expense insurance. The plan must provide hospital, surgical, or medical expense insurance; supplemental policies for a specified disease or other limited benefit are excepted. Services must be within the pharmacist's scope of practice under state law.

Health plans and carriers must not discriminate against pharmacists solely because of their license type. The pharmacist must act within the scope of their state license and be willing to follow the plan's participation terms. The rule covers participation, referrals, payment, and indemnification for services the plan covers. Plans may set network limits, referrals, and other measures to meet enrollee needs, maintain quality, and control costs. They need not contract with every willing provider or cover services outside the plan.

Pharmacists may prescribe certain FDA-approved drugs, drug categories, or devices for children ages five through eleven. This authority is for patients who are at least five but under twelve years old and does not cover controlled substances. The treatment must follow FDA-approved labeling and address a condition that needs no new diagnosis, is minor and generally self-limiting, or involves a waived test for influenza, COVID-19, strep, or RSV. Drugs requiring a certified education program and limited distribution network are excluded. After testing or treatment, the pharmacist must notify the child's primary care provider as soon as practical, consistent with federal privacy law, or refer the child to a provider if the child has or shares none.

A supervising pharmacist may delegate certain preparation, processing, and final product verification tasks to a pharmacy technician or intern. Allowed verification tasks include a second technician or intern checking another worker's work, barcode or other technology checks before a health-care provider gives a product, and checks during bulk-to-unit-dose repackaging. The tasks may not involve controlled substances. A technician cannot use discretion or clinical judgment. Pharmacies must maintain a system to check accuracy and record and review errors, including errors that do not reach a patient. A pharmacy using a final product verification program must maintain a plan for pharmacist hours and direct patient care. The pharmacy board must adopt rules on training, excluded medicines, liability, and other matters by December 31, 2026. The pharmacy board must adopt the required rules no later than December 31, 2026.

A pharmacist is eligible for payment under Colorado's medical assistance program for medically necessary services within the pharmacist's scope of practice. This applies to pharmacists seeking reimbursement through Colorado's medical assistance program. The service must not duplicate another pharmacist service or program paid for under the medical assistance program.