{"data":{"id":"us-co/c.r.s.-10-16-103.6","jurisdiction":"us-co","citation":"C.R.S. § 10-16-103.6","heading":"Copayment-only prescription payment structures - required inclusion in health benefit plans - rules.","body":"(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.\n\n(b) For each copayment-only payment structure for prescription drugs:\n\n(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;\n\n(II) The copayment amounts between the two highest prescription drug cost tiers must have a cost difference of at least ten percent;\n\n(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\n\n(IV) Each carrier shall use \"Rx Copay\" at the end of the marketing names for each copayment-only payment structure.\n\n(2) The commissioner may promulgate rules to implement and enforce this section.","path":["Title INSURANCE - MUTUAL INSURANCE","Article 16 - Health-care Coverage","Part 1 - GENERAL PROVISIONS"],"source_url":"https://olls.info/crs/crs2026-title-10.htm","current_through":"Colorado Revised Statutes 2026","vintage":"","retrieved_at":"2026-09-14T18:37:45Z","sha256":"0879dc1fcd62b25ea7a6c85f5f717a17258500eb863e51da82902bf020584c0f","source_id":"us-co","stale":false,"prev":"us-co/c.r.s.-10-16-103.5","next":"us-co/c.r.s.-10-16-104"},"notice":"GroundRules: Original legal text. Not legal advice."}