This is what is happening in Colorado …
I’m looking for help with having a PBM trying to deny coverage because of a MME. My state (Colorado) has passes a law that says these pbm cannot deny coverage because of a predetermined mme. The pbm doesn’t feel that they are under that same law. I am denied getting coverage because of this. For the record the name of he law for my state is called The act senate bill 23-144 in case you would like to see what Colorado has done for its chronic pain patients. Here is a hyperlink to the text of the Colorado law https://pluralpolicy.com/app/legislative-tracking/bill/details/state-co-2023a-sb23144/1266204 Here is an excerpt from the law:The act also prohibits a pharmacy, health insurance carrier, or pharmacy benefit manager from having a policy in place that requires a pharmacist to refuse to fill a prescription for an opiate issued by a health-care provider solely because the prescription is for an opiate or because the prescription order exceeds a predetermined morphine milligram equivalent dosage recommendation or threshold.
Apparently this particular PBM believes that they are exempt from state law, even though most all PBM’s are licensed insurance companies and would have to have a state license to furnish product/services within states they are operating in.
Under this law, any/all PBM’s would be under the over sight of the state Insurance Commissioner and since this state has a state law that in particular denotes that PBM’s are covered under the law, the state Attorney General may come into play on enforcing the law.
Some times state legislators, are not happy when they pass laws that none of the state agencies will enforce the law. A lot of tax dollars going to waste, first on the legislators passing the bill and then all the state agencies failing to do their job.
Filed under: General Problems
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