Colorado § 25.5-5-511 - Reimbursement for pharmacists' services - legislative declaration.

§ 25.5-5-511. Reimbursement for pharmacists' services - legislative declaration.

(1) (a) The general assembly finds and declares that:

(I) Pharmacists are highly trained and educated doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;

(II) Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;

(III) With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments;

(IV) As part of an integrated team, pharmacists have been proven to lower the overall cost of health care and improve long-term chronic disease outcomes; however, despite these recognized benefits, pharmacists are not considered reimbursable medical providers;

(V) Further, pharmacists in integrated medical homes under the medical assistance program are not supported by the same funding mechanisms as other providers, including rate setting for federally qualified health centers or through fee-for-service billing;

(VI) Without the ability to generate revenue through direct reimbursement or new value-based models, the services pharmacists provide are not sustainable;

(VII) Colorado has recognized that there is a shortage in primary care providers for individuals enrolled in the medical assistance program; and

(VIII) Pharmacists can help address this shortage by providing certain primary care services as a follow-up to physician care through collaborative practice models, including the provision of chronic disease management.

(b) Therefore, the general assembly declares that the ability of pharmacists to generate revenue for the same services provided by other health-care providers would be equitable, would help fund staff and services in medical homes, and would alleviate barriers to access of care in community settings.

(2) (a) A pharmacist is eligible to receive reimbursement under the medical assistance program for medically necessary services that are within the pharmacist's scope of practice pursuant to article 280 of title 12 and that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program.

(b) The state department shall include the services reimbursed pursuant to subsection (2)(a) of this section in the review of provider rates required pursuant to section 25.5-4-401.5.

(3) The state department shall request any federal authorization necessary to receive federal financial participation under the medical assistance program.

Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3377, § 1, effective September 7. L. 2026: (2)(a) amended, (HB 26-1336), ch. 236, p. 1363, § 4, effective August 12.