Prescriber Tool Alternative Payment Model
Program Overview
The Prescriber Tool Alternative Payment Model (APM) is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate.
Program Year 1
The APM launched with Program Year 1 (PY1) on October 2nd, 2023. To earn payment, eligible practices were required to access their Prescriber Tool Dashboard, complete a brief RTBI training and attestation, and submit a Data Quality Validation and Feedback Survey by April 19th, 2024. 855 practices successfully completed the required activities to earn a shared savings payment, which the Department distributed on June 19th, 2024. In PY1, the Department was authorized to share 100% of savings with practices and distributed $1.15 million in total.
Program Year 2
Program Year 2 (PY2) began on October 1st, 2024, with the announcement of stakeholder engagement webinars which took place on October 28th and 29th, 2024. A recording can be found on this page under “Past Webinars.”
To earn payment, eligible practices were required to complete a feedback survey. The survey was opened in January 2025 and closed in April 2025. 701 practices successfully completed the required activities to earn a shared savings payment, which the Department distributed on June 30th, 2025. In PY2, the Department was authorized to share 75% of savings and distributed $459,497.30 in total.
Program Year 3
Program Year 3 (PY3) will begin on October 1st, 2025. PY3 will run similar to PY2. In October the Department will post a webinar outlining any changes and updates to the program. In January 2026, the Department will release the required activity for completion by April 2026. The Department is authorized to share 50% of the shared savings.
Who is eligible to participate?
The Prescriber Tool APM is open to Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims. The APM does not have a minimum attributed member size limit. Practices are automatically enrolled in the Prescriber Tool APM if relevant claims are attributed to the practice for the program year.
A list of eligible NPIs will be posted in October 2025
Past Webinars
The Department hosted informational sessions about the Prescriber Tool APM design for Program Year 2 in October 2024
Program Year 2
Program Resources
- Prescriber Tool Webpage
- Reducing Prescription Drug Costs in Colorado Report
- Real-Time Benefits Inquiry Training
- Prescriber Tool APM Program Overview
Contact Information
Email hcpf_pharmacyapm@state.co.us for more information about the program.