3 CCR 702-4-2-58-6 - Required Drug Copayment-only Payment Structures

For each of a carrier's service areas, no fewer than twenty-five percent (25%) of the plans offered for each metal level (Platinum, Gold, Silver and Bronze) must contain a copayment-only payment structure for all drug tiers. Carriers shall not apply the deductible or any coinsurance amount for these plans. Carriers must meet the requirements of this section by offering at least one plan, other than an Colorado Option Standardized Plan, that will count as part of the 25% minimum. However, if a carrier only offers Colorado Option standardized plans within a service area, the carrier is considered to have met the 25% minimum requirement in this section but must comply with all other requirements in this section

A. The highest allowable copayment for the highest cost drug tier(s) must be no greater than 1/12^th of the plan's "individual" annual out-of-pocket maximum.

B. Copayments between the two highest cost tiers shall have a meaningful difference of at least ten percent (10%).

C. For all tiers, carriers shall not employ benefit designs that will have the effect of discouraging individuals with significant prescription needs from enrolling in certain health benefit plans.

D. Cost-sharing arrangements that utilize coinsurance up to a capped dollar amount maximum are not considered copayments and cannot be used to meet the all-copayment structure requirement.

E. Carriers must meet the requirements of Section 6 separately for plans offered on the Exchange and plans that are offered off the Exchange.

F. Carriers must meet the requirements of this Section by offering at least one plan, other than a Colorado Option Standardized Plan, that will count as part of the 25% minimum. However, if a carrier only offers Colorado Option standardized plans within a service area, the carrier is considered to have met the 25% minimum requirement in this section but must comply with all other requirements in this section.

Notes

3 CCR 702-4-2-58-6

37 CR 11, June 10, 2014, effective 7/1/2014 37 CR 12, June 25, 2014, effective 7/15/2014 Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/2014 37 CR 23, December 10, 2014, effective 1/1/2015 38 CR 03, February 10, 2015, effective 3/15/2015 38 CR 06, March 25, 2015, effective 4/30/2015 38 CR 09, May 10, 2015, effective 6/1/2015 38 CR 13, July 10, 2015, effective 7/30/2015 38 CR 19, October 10, 2015, effective 11/1/2015 38 CR 21, November 10, 2015, effective 1/1/2016 38 CR 23, December 10, 2015, effective 1/1/2016 39 CR 01, January 10, 2016, effective 2/1/2016 39 CR 05, March 10, 2016, effective 4/1/2016 39 CR 08, April 25, 2016, effective 5/15/2016 39 CR 19, October 10, 2016, effective 11/1/2016 39 CR 20, October 25, 2016, effective 1/1/2017 39 CR 22, November 25, 2016, effective 1/1/2017 39 CR 23, December 10, 2016, effective 1/1/2017 39 CR 23, December 25, 2016, effective 1/1/2017 40 CR 03, February 10, 2017, effective 3/15/2017 40 CR 09, May 10, 2017, effective 6/1/2017 40 CR 15, August 10, 2017, effective 9/1/2017 40 CR 17, September 10, 2017, effective 10/1/2017 40 CR 21, November 10, 2017, effective 12/1/2017 41 CR 04, February 25, 2018, effective 4/1/2018 41 CR 05, March 10, 2018, effective 6/1/2018 41 CR 08, April 25, 2018, effective 6/1/2018 41 CR 09, May 10, 2018, effective 6/1/2018 41 CR 11, June 10, 2018, effective 7/1/2018 41 CR 15, August 10, 2018, effective 9/1/2018 41 CR 17, September 10, 2018, effective 10/1/2018 41 CR 18, September 25, 2018, effective 10/15/2018 41 CR 21, November 10, 2018, effective 12/1/2018 41 CR 23, December 10, 2018, effective 1/1/2019 42 CR 01, January 10, 2019, effective 2/1/2019 41 CR 19, October 10, 2018, effective 3/1/2019 42 CR 03, February 10, 2019, effective 4/1/2019 42 CR 04, February 25, 2019, effective 4/1/2019 42 CR 06, March 25, 2019, effective 6/1/2019 42 CR 08, April 10, 2019, effective 6/1/2019 42 CR 15, August 10, 2019, effective 9/1/2019 42 CR 17, September 10, 2019, effective 10/1/2019 43 CR 02, January 25, 2020, effective 12/20/2019 43 CR 02, January 25, 2020, effective 12/23/2019 42 CR 23, December 10, 2019, effective 1/1/2020 43 CR 01, January 10, 2020, effective 2/1/2020 42 CR 24, December 25, 2019, effective 2/2/2020 43 CR 06, March 25, 2020, effective 4/15/2020 43 CR 10, May 25, 2020, effective 8/1/2020 43 CR 14, July 25, 2020, effective 8/15/2020 43 CR 17, September 10, 2020, effective 10/1/2020 43 CR 18, September 25, 2020, effective 11/1/2020 43 CR 22, November 25, 2020, effective 12/15/2020 43 CR 24, December 25, 2020, effective 1/15/2021 44 CR 03, February 10, 2021, effective 3/15/2021 44 CR 08, April 25, 2021, effective 5/15/2021 44 CR 09, May 10, 2021, effective 6/1/2021 44 CR 10, May 25, 2021, effective 6/14/2021 44 CR 10, May 25, 2021, effective 6/15/2021 44 CR 13, July 10, 2021, effective 8/1/2021 44 CR 15, August 10, 2021, effective 9/1/2021 44 CR 19, October 10, 2021, effective 11/1/2021 44 CR 21, November 10, 2021, effective 12/1/2021 44 CR 23, December 10, 2021, effective 12/30/2021 44 CR 21, November 10, 2021, effective 1/1/2022 44 CR 23, December 10, 2021, effective 1/15/2022 44 CR 24, December 25, 2021, effective 1/15/2022 45 CR 03, February 10, 2022, effective 3/2/2022 45 CR 08, April 25, 2022, effective 5/30/2022 45 CR 09, May 10, 2022, effective 5/30/2022 45 CR 10, May 25, 2022, effective 6/14/2022 45 CR 11, June 10, 2022, effective 6/30/2022 45 CR 11, June 10, 2022, effective 7/15/2022 45 CR 19, October 10, 2022, effective 11/1/2022 45 CR 20, October 25, 2022, effective 11/14/2022 45 CR 21, November 10, 2022, effective 11/30/2022 45 CR 24, December 25, 2022, effective 1/14/2023 46 CR 01, January 10, 2023, effective 2/14/2023 46 CR 06, March 25, 2023, effective 2/15/2023 46 CR 03, February 10, 2022, effective 3/2/2023 46 CR 04, February 25, 2023, effective 3/17/2023 46 CR 05, March 10, 2023, effective 4/15/2023 46 CR 09, May 10, 2023, effective 5/30/2023 46 CR 09, May 10, 2023, effective 6/1/2023 46 CR 10, May 25, 2023, effective 6/15/2023 46 CR 11, June 10, 2023, effective 6/30/2023 48 CR 09, May 10, 2025, effective 5/30/2025