3 CCR 702-4-2-104-7 - Carrier Exemption
A. Pursuant
to ยง
10-16-163(2)(g),
C.R.S., a carrier may exempt a segment of its business from the required
contract terms disclosure requirements if:
1.
The carrier provides the majority of covered medical professional services
through a single, contracted medical group; and
2. operates its own pharmacies through which
at least 85% of its aggregate prescription drug claims are
filled.
B. If a carrier
meets the criteria in subsection A, the carrier shall submit the "Prescription
Drug Contract Terms Exemption Form", as found in Appendix B of this regulation,
as part of the carrier's "Pharmacy Benefit Transparency Filing" in
SERFF.
C. For segments of the
carrier's business that do not meet the exemption terms in Section 7.A of this
regulation, the carrier, or a PBM at the request of a carrier, shall comply
with Sections 5 and 6 of this regulation.
Notes
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