Colorado § 10-16-144 - Health-care services provided by pharmacists.

§ 10-16-144. Health-care services provided by pharmacists.

(1) A health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance must provide coverage for health-care services provided by a pharmacist if:

(a) The pharmacist is providing services that are within the pharmacist's scope of practice under article 280 of title 12;

(b) The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice registered nurse;

(c) The pharmacist is included in the health benefit plan's network of participating providers; and

(d) A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.

(2) (a) If a pharmacist is willing to abide by the terms and conditions for participation established by the health benefit plan or carrier, a health benefit plan or carrier shall not discriminate, with respect to participation, referral, or reimbursement of covered services or indemnification as to pharmacists who are acting within the scope of their license under state law, solely on the basis of the type of licensure. In selecting providers of health-care services for membership in a provider network, a health benefit plan or carrier shall not discriminate against pharmacists who provide services that are covered by the plan by prohibiting pharmacists from membership in a provider network.

(b) Subsection (2)(a) of this section shall not be construed as:

(I) Prohibiting a health benefit plan or carrier from including providers in a provider network only to the extent necessary to meet the needs of the health benefit plan and its enrollees or from limiting referrals or establishing any other measure designed to maintain quality and control costs consistent with the provisions of the health benefit plan;

(II) Requiring a health benefit plan or carrier to contract with any provider willing to abide by the terms and conditions for participation established by the health benefit plan or carrier; or

(III) Requiring coverage for any service that is not otherwise covered under the terms of a health benefit plan.

(3) (a) Notwithstanding the provisions of subsection (1) of this section to the contrary, a health benefit plan described in subsection (1) of this section that provides treatment for substance use disorders shall reimburse a licensed pharmacist acting within the licensed pharmacist's scope of practice, and in accordance with the requirements in part 6 of article 280 of title 12, for the provision of medication-assisted treatment services if the health benefit plan provides coverage for the same services provided by a licensed physician or an advanced practice registered nurse.

(b) A health benefit plan reimbursing a licensed pharmacist pursuant to subsection (3)(a) of this section shall reimburse a licensed pharmacist at the same rate that the health benefit plan reimburses a licensed physician or an advanced practice registered nurse within the health benefit plan's network of participating providers for the same services.

Source: L. 2016: Entire section added, (SB 16-135), ch. 239, p. 981, § 1, effective August 10. L. 2018: (2) added, (HB 18-1112), ch. 112, p. 806, § 1, effective August 8. L. 2019: (1)(a) amended, (HB 19-1172), ch. 136, p. 1657, § 52, effective October 1. L. 2024: (3) added, (HB 24-1045), ch. 470, p. 3277, § 2, effective August 7. L. 2026: IP(1), (1)(a), and (2) amended, (HB 26-1336), ch. 236, p. 1359, § 1, effective August 12.