Prescription Drug Out-of-Pocket Expense Credit

Summary

Beginning Jan. 1, 2028, health insurers in Colorado must count the money a member spends directly on prescription drugs toward that member’s annual out‑of‑pocket maximum or cost‑sharing requirement. Members must submit proof of payment within 90 days, and the credit cannot exceed what the member would have paid if the drug were obtained from an in‑network pharmacy. The credit is denied if proof isn’t provided, the drug isn’t on the plan’s formulary, or the member bypasses required utilization‑management steps.

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