A Bill for an Act
Page 1, Line 101Concerning authorization for a health-care provider to
Page 1, Line 102adjust a chronic maintenance drug prescription
Page 1, Line 103without prior authorization from an insurance
Page 1, Line 104carrier.
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 allows a health-care provider to, under certain circumstances, adjust the dose or frequency of a chronic maintenance drug without needing prior authorization from an insurance carrier.
Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:
Page 2, Line 2SECTION 1. In Colorado Revised Statutes, 10-16-124.5, add (6.2) as follows:
Page 2, Line 310-16-124.5. Prior authorization form - drug benefits -
Page 2, Line 4program - chronic maintenance drugs - rules of commissioner -
Page 2, Line 5definitions - repeal. (6.2) Consistent with available
Page 2, Line 6evidence-based guidelines, a prescribing provider may adjust the
Page 2, Line 7dose or frequency of a prescription drug to meet the specific
Page 2, Line 8medical needs of a covered person without prior authorization
Page 2, Line 9or subsequent utilization management, as defined in section 10-16-1002 (10), related to the dose or frequency adjustment if:
Page 2, Line 10(a) The prescription drug is a chronic maintenance drug,
Page 2, Line 11as defined in section 12-280-103 (9.5), that has previously been
Page 2, Line 12approved for coverage by the carrier or PBM for the covered
Page 2, Line 13person's chronic or debilitating disease and the prescribing
Page 2, Line 14provider continues to prescribe the drug for the same chronic or debilitating disease;
Page 2, Line 15(b) The prescription drug is not an opioid or a scheduled controlled substance; and
Page 2, Line 16(c) The dose or frequency has not been adjusted more than two times without prior authorization.
Page 2, Line 17SECTION 2. Act subject to petition - effective date. This act
Page 2, Line 18takes effect at 12:01 a.m. on the day following the expiration of the
Page 2, Line 19ninety-day period after final adjournment of the general assembly; except
Page 2, Line 20that, if a referendum petition is filed pursuant to section 1 (3) of article V
Page 2, Line 21of the state constitution against this act or an item, section, or part of this
Page 3, Line 1act within such period, then the act, item, section, or part will not take
Page 3, Line 2effect unless approved by the people at the general election to be held in
Page 3, Line 3November 2026 and, in such case, will take effect on the date of the official declaration of the vote thereon by the governor.