Second Regular Session
Seventy-third General Assembly
STATE OF COLORADO
REREVISED
This Version Includes All Amendments
Adopted in the Second House
LLS NO. 22-0786.01 Christy Chase x2008
HOUSE BILL 22-1264
House Committees Senate Committees
Agriculture, Livestock, & Water Health & Human Services
A BILL FOR AN ACT
C
ONCERNING UPDATING REFERENCE S TO THE FEDERAL FOOD AND101
DRUG ADMINISTRATION IN TH E HEALTH INSURANCE LAW .102
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/
.)
Statutory Revision Committee. The bill strikes references to the
federal food and drug administration in the health insurance code and
replaces the references with the term "FDA", which is defined for the
entire code to mean the federal food and drug administration.
SENATE
3rd Reading Unamended
April 7, 2022
SENATE
2nd Reading Unamended
April 6, 2022
HOUSE
3rd Reading Unamended
March 17, 2022
HOUSE
2nd Reading Unamended
March 16, 2022
HOUSE SPONSORSHIP
Valdez D. and Woodrow, Lynch, Pico, Boesenecker, Esgar, Exum, Jodeh, Snyder
SENATE SPONSORSHIP
Moreno and Woodward, Kirkmeyer, Zenzinger, Priola
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute. Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, 10-16-104, amend2
(5.5)(a)(III)(B) and (21)(a) as follows:3
10-16-104. Mandatory coverage provisions - definitions -4
rules. (5.5) Behavioral, mental health, and substance use disorders5
- rules. (a) (III) (B) A health benefit plan subject to this subsection (5.5)6
must provide coverage without prior authorization for a five-day supply7
of at least one of the federal food and drug administration-approved8
FDA-
APPROVED drugs for the treatment of opioid dependence; except that9
this requirement is limited to a first request within a twelve-month period.10
(21) Oral anticancer medication. (a) Any health benefit plan11
that provides coverage for cancer chemotherapy treatment shall provide12
coverage for prescribed, orally administered anticancer medication that13
has been approved by the federal food and drug administration
FDA and14
is used to kill or slow the growth of cancerous cells. The orally15
administered medication shall be provided at a cost to the covered person16
not to exceed the coinsurance percentage or the copayment amount as is17
applied to an intravenously administered or an injected cancer medication18
prescribed for the same purpose. A medication provided pursuant to this19
subsection (21) shall be prescribed only upon a finding that it is medically20
necessary by the treating physician for the purpose of killing or slowing21
the growth of cancerous cells in a manner that is in accordance with22
nationally accepted standards of medical practice, clinically appropriate23
in terms of type, frequency, extent site, and duration, and not primarily for24
the convenience of the patient, physician, or other health-care provider.25
This subsection (21) does not require the use of orally administered26
medications as a replacement for other cancer medications. Nothing in27
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-2- this subsection (21) prohibits coverage for oral generic medications in a1
health benefit plan. Nothing in this subsection (21) prohibits a carrier2
from applying an appropriate formulary or other clinical management to3
any medication described in this subsection (21). For the purposes of this4
subsection (21), the treating physician for a patient covered under a health5
maintenance organization's health benefit plan shall be a physician who6
is designated by and affiliated with the health maintenance organization.7
SECTION 2. In Colorado Revised Statutes, 10-16-104.6, amend8
(1) introductory portion as follows:9
10-16-104.6. Off-label use of cancer drugs. (1) A health benefit10
plan that provides coverage for prescription drugs shall not limit or11
exclude coverage for any drug approved by the United States food and12
drug administration FDA for use in the treatment of cancer on the basis13
that the drug has not been approved by the United States food and drug14
administration FDA for the treatment of the specific type of cancer for15
which the drug is prescribed if:16
SECTION 3. In Colorado Revised Statutes, 10-16-112.5, amend17
(7)(c)(I) as follows:18
10-16-112.5. Prior authorization for health-care services -19
disclosures and notice - determination deadlines - criteria - limits and20
exceptions - definitions - rules. (7) Definitions. As used in this section:21
(c) "Medical necessity" means a determination by the carrier that22
a prudent provider would provide a particular covered health-care service23
to a patient for the purpose of preventing, diagnosing, or treating an24
illness, injury, disease, or symptom in a manner that is:25
(I) In accordance with generally accepted standards of medical26
practice and approved by the federal food and drug administration FDA27
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SECTION 4. In Colorado Revised Statutes, 10-16-124.7, amend2
(3)(a) as follows:3
10-16-124.7. Opioid analgesics with abuse-deterrent4
properties - study - definitions. (3) As used in this section:5
(a) "Abuse-deterrent opioid analgesic drug product" means a6
brand or generic opioid analgesic drug product approved by the United7
States food and drug administration FDA with abuse-deterrence labeling8
claims that indicate that the drug product is expected to result in a9
meaningful reduction in abuse.10
SECTION 5. In Colorado Revised Statutes, 10-16-148, repeal (2)11
as follows:12
10-16-148. Medication-assisted treatment - limitations on13
carriers - rules. (2) As used in this section, "FDA" means the food and14
drug administration in the United States department of health and human15
services.16
SECTION 6. Act subject to petition - effective date. This act17
takes effect at 12:01 a.m. on the day following the expiration of the18
ninety-day period after final adjournment of the general assembly; except19
that, if a referendum petition is filed pursuant to section 1 (3) of article V20
of the state constitution against this act or an item, section, or part of this21
act within such period, then the act, item, section, or part will not take22
effect unless approved by the people at the general election to be held in23
November 2022 and, in such case, will take effect on the date of the24
official declaration of the vote thereon by the governor.25
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