Colorado § 10-16-1503 - Definitions.

§ 10-16-1503. Definitions.

As used in this part 15, unless the context otherwise requires:

(1) "340B covered entity" means a covered entity, as defined in section 340B (a)(4) of the federal "Public Health Service Act", 42 U.S.C. sec. 256b (a)(4), as amended.

(2) "340B drug" means a drug purchased through the 340B drug pricing program by a 340B covered entity.

(3) "340B drug pricing program" or "340B program" means the program described in 42 U.S.C. sec. 256b.

(4) "Contract pharmacy" means a pharmacy operating under contract with a 340B covered entity to provide dispensing services to the 340B covered entity as described in 75 Fed. Reg. 10272 (2010) or any superseding guidance.

(5) (a) "Drug coverage" means coverage or payment for a prescription drug dispensed by a pharmacy to a patient pursuant to:

(I) A health coverage plan;

(II) A managed care organization, as defined in section 25.5-5-403 (5); or

(III) Any other contractual or other legal obligation to provide coverage or payment for a prescription drug dispensed by a pharmacy to a patient.

(b) "Drug coverage" does not include:

(I) Reimbursement for covered outpatient drugs, as that term is defined in section 42 U.S.C. sec. 1396r-8 (k)(2), on a fee-for-service basis under the medicaid program; or

(II) Any amounts paid by an individual on the individual's own behalf or on behalf of another individual without a contractual or legal obligation to do so.

(6) "Medicaid program" means the medical assistance program established pursuant to articles 4 to 6 of title 25.5.

(7) (a) "Third party" means:

(I) A carrier or pharmacy benefit manager that provides or manages drug coverage under a health coverage plan; or

(II) A system of health insurance for state or local government employees, their dependents, and retirees, including a group benefit plan, as defined in section 24-50-603 (9), and a group health-care program designed pursuant to section 24-51-1202.

(b) "Third party" does not include:

(I) An insurer that provides coverage under a policy of property and casualty insurance; or

(II) An insurer or entity that provides health coverage, benefits, or coverage of prescription drugs as part of coverage required under the "Workers' Compensation Act of Colorado", articles 40 to 47 of title 8, or workers' compensation coverage required under federal law.

Source: L. 2022: Entire part added, (HB 22-1122), ch. 312, p. 2231, § 1, effective August 10.