ColoradoColorado insurers credit eligible direct drug payments toward plan limits
Starting January 1, 2028, Colorado insurers must count eligible direct payments for prescription drugs toward a person’s plan limit for out-of-pocket costs after receiving proof.
What it does
Starting in 2028, insurers must count eligible direct payments for prescription drugs toward a person’s plan limit for out-of-pocket costs, subject to proof and plan rules.
Argument forPeople who pay a pharmacy or direct-to-consumer platform themselves could have eligible drug costs count toward their plan’s out-of-pocket limit.
Argument againstPeople could receive credit for less than they paid if the drug cost more than the plan’s in-network amount, or if they miss proof or plan requirements.
More detail
Insurers must credit eligible prescription drug payments toward a covered person’s out-of-pocket maximum or cost-sharing requirement. This applies to people covered by individual or group health plans in Colorado who buy a prescription drug and pay a pharmacy or direct-to-consumer platform directly. The person must give the insurer proof of payment within 90 days of purchase; an itemized receipt or pharmacy record may show proof. Credit cannot exceed what the person would have paid for the same drug at an in-network pharmacy under the plan. No credit is allowed for a drug outside the plan’s covered list unless the insurer grants an exception, or if the person does not follow required plan steps, including prior authorization or step therapy. The credit rule begins January 1, 2028. The act’s general effective date is August 12, 2026, unless a referendum petition is filed; if voters approve it in November 2026, it takes effect when the governor officially declares the vote.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 3Governor Jared Polis SignedBecame Law
- May 21Signed by the President of the SenateMajor
- May 21Signed by the Speaker of the HouseMajor
- May 21Sent to the GovernorTo Governor
- May 9House Third Reading Passed - No AmendmentsPassed House
- Vote recorded BILL. Result: pass.Lower
- May 8House Committee on Health & Human Services Refer Unamended to House Committee of the WholeMinor
- Vote recorded Refer Senate Bill 26-167 to the Committee of the Whole. Result: pass.Upper
- Vote recorded Refer Senate Bill 26-167 to the Committee of the Whole. Result: pass.Lower
- May 8House Second Reading Special Order - Passed - No Amendments
- May 6Senate Third Reading Passed - No AmendmentsPassed Senate
- Vote recorded BILL. Result: pass.Upper
- May 6Introduced In House - Assigned to Health & Human ServicesMinor
- May 5Senate Committee on Appropriations Refer Unamended to Senate Committee of the WholeMinor
- Vote recorded Refer Senate Bill 26-167 to the Committee of the Whole. Result: pass.Upper
- May 5Senate Second Reading Special Order - Passed with Amendments - Committee
- Apr 30Senate Committee on Health & Human Services Refer Amended to AppropriationsMinor
- Vote recorded Refer Senate Bill 26-167, as amended, to the Committee on Appropriations. Result: pass.Upper
- Vote recorded Adopt amendment L.001 (Attachment B). Result: pass.Upper
- Apr 16Introduced In Senate - Assigned to Health & Human ServicesIntroduced
Healthcare