CO| The Colorado Insurance Division has amended Regulation 4-2-103 (3 CCR 702-4) establishing requirements for carriers and PBMs to submit and, in some cases, publicly post standardized Transparency in Coverage (TiC) machine-readable files and prescription drug data collection (RxDC) reports, aligned with federal rules at 45 CFR 147.212 and 45 CFR 149.10–149.740 and limited to Colorado-issued coverage and Colorado-specific data.
- Beginning July 1, 2025 and January 1, 2026 (and semiannually thereafter), carriers must submit three JSON TiC files (table of contents, in-network negotiated rates, and out-of-network allowed amounts/billed charges) filtered to Colorado plans, Colorado NPIs, and procedure codes with at least 20 services in the prior year; alternative formats may be approved only upon documented material challenge with JSON.
- TiC table-of-contents files must use standardized labels (carrier name, plan name, market segment, group EIN/HIOS ID, file size/row count, file generation date, and URL to the plan-specific file on the carrier’s website) and clearly identify when a carrier is acting as a TPA.
- By July 1, 2025 and annually thereafter, carriers and PBMs must submit CMS RxDC plan lists (P1–P3), data files (D1–D8, with D1–D2 not applicable to PBMs), and narratives via secure file transfer, with data filtered to Colorado plans; the Division will accept updated CMS templates if CMS changes the RxDC format.
- TiC files are presumptively public (may not be labeled confidential), while RxDC submissions may be partially protected if the carrier/PBM files a detailed “Confidentiality Index”; all unmarked information is treated as a public record subject to the Colorado Open Records Act.
- The regulation incorporates federal TiC and RxDC regulations by reference, provides for enforcement through civil penalties, cease-and-desist orders, and licensure actions for noncompliance, and sets an effective date of January 30, 2026 (with the underlying regulation originally effective April 14, 2025).