A Bill for an Act
Page 1, Line 101Concerning parity for the use of non-opioid pain management
Page 1, Line 102drugs.
Bill Summary
(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)
The bill requires a health insurance carrier that provides prescription drug benefits to require that:
- The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain;
- There is at least one clinically appropriate non-opioid prescription drug available as an alternative for each opioid prescription drug; and
- The cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.
The bill requires the department of health care policy and financing to ensure that the utilization review requirements, including prior authorization or step therapy, for a non-opioid prescription drug prescribed and approved by the FDA for the treatment or management of chronic or acute pain are no more restrictive than the least restrictive utilization requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 10-16-145.5, add
Page 2, Line 3(2.5) as follows:
Page 2, Line 410-16-145.5. Step therapy - prior authorization - prohibited -
Page 2, Line 5stage four advanced metastatic cancer - non-opioid pain management
Page 2, Line 6drug - definitions.
Page 2, Line 7(2.5) Notwithstanding section 10-16-145, a carrier that
Page 2, Line 8provides prescription drug benefits shall require that:
Page 2, Line 9(a) The utilization review requirements, including prior
Page 2, Line 10authorization and step therapy, for a non-opioid drug prescribed
Page 2, Line 11and approved by the FDA for the treatment or management of
Page 2, Line 12chronic or acute pain are no more restrictive than the least
Page 2, Line 13restrictive utilization review requirements for opioid drugs
Page 2, Line 14prescribed for the treatment or management of chronic or
Page 3, Line 1acute pain;
Page 3, Line 2(b) There is at least one clinically appropriate non-opioid
Page 3, Line 3prescription drug available as an alternative for each opioid
Page 3, Line 4prescription drug; and
Page 3, Line 5(c) The cost-sharing, copayment, or deductible for a
Page 3, Line 6non-opioid drug prescribed for the treatment or management of
Page 3, Line 7chronic or acute pain is no greater than the cost-sharing,
Page 3, Line 8copayment, or deductible for an opioid drug prescribed for the
Page 3, Line 9treatment or management of chronic or acute pain.
Page 3, Line 10SECTION 2. In Colorado Revised Statutes, add 25.5-5-520 as
Page 3, Line 11follows:
Page 3, Line 1225.5-5-520. Non-opioid prescription drugs for treating or
Page 3, Line 13managing chronic or acute pain - no prior authorization or step
Page 3, Line 14therapy - definition.
Page 3, Line 15(1) As used in this section, unless the context otherwise
Page 3, Line 16requires:
Page 3, Line 17(a) "Prescription drug" has the same meaning set forth in
Page 3, Line 18section 12-280-103.
Page 3, Line 19(2) The state department shall require that the
Page 3, Line 20utilization review requirements, including prior authorization
Page 3, Line 21or step therapy, for a non-opioid drug prescribed and approved
Page 3, Line 22by the federal food and drug administration for the treatment
Page 3, Line 23or management of chronic or acute pain are no more restrictive
Page 3, Line 24than the least restrictive utilization requirements for opioid
Page 3, Line 25drugs prescribed for the treatment or management of chronic
Page 3, Line 26or acute pain.
Page 3, Line 27(3) This section applies to a fee-for-service medical
Page 4, Line 1assistance plan and a health maintenance organization that has
Page 4, Line 2a contract with the state department and provides coverage for
Page 4, Line 3prescription drugs.
Page 4, Line 4(4) This section does not prohibit the state department
Page 4, Line 5from contracting with a managed care organization for
Page 4, Line 6pharmaceutical services offered under the state medical
Page 4, Line 7assistance program pursuant to this article 5 and articles 4 and
Page 4, Line 86 of this title 25.5 if the contract complies with this section.
Page 4, Line 9SECTION 3. Act subject to petition - effective date. This act
Page 4, Line 10takes effect at 12:01 a.m. on the day following the expiration of the
Page 4, Line 11ninety-day period after final adjournment of the general assembly (August
Page 4, Line 1212, 2026, if adjournment sine die is on May 13, 2026); except that, if a
Page 4, Line 13referendum petition is filed pursuant to section 1 (3) of article V of the
Page 4, Line 14state constitution against this act or an item, section, or part of this act
Page 4, Line 15within such period, then the act, item, section, or part will not take effect
Page 4, Line 16unless approved by the people at the general election to be held in
Page 4, Line 17November 2026 and, in such case, will take effect on the date of the
Page 4, Line 18official declaration of the vote thereon by the governor.