Copayment-only prescription payment structures - required inclusion in health benefit plans - rules

(1) (a) In addition to the requirements in section 10-16-103.4 (2), for health benefit plans issued or renewed on or after January 1, 2023, each carrier that offers an individual or small group health benefit plan shall offer at least twenty-five percent of its health benefit plans on the exchange and at least twenty-five percent of its plans not on the exchange in each bronze, silver, gold, and platinum benefit level in each service area as copayment-only payment structures for all prescription drug cost tiers.

(b) For each copayment-only payment structure for prescription drugs:

(I) The copayment amount for the highest prescription drug cost tier must not be greater than one-twelfth of the health benefit plan's out-of-pocket maximum amount;

(II) The copayment amounts between the two highest prescription drug cost tiers must have a cost difference of at least ten percent;

(III) No more than fifty percent of the drugs on the prescription drug formulary used to treat a specific condition may be placed on the highest prescription drug cost tier; and

(IV) Each carrier shall use Rx Copay at the end of the marketing names for each copayment-only payment structure.

(2) The commissioner may promulgate rules to implement and enforce this section.