HOUSE BILL 22-1264
BY REPRESENTATIVE(S) Valdez D. and Woodrow, Lynch, Pico,
Boesenecker, Esgar, Exum, Jodeh, Snyder;
also SENATOR(S) Moreno and Woodward, Kirkmeyer, Zenzinger, Priola.
C
ONCERNING UPDATING REFERENCES TO THE FEDERAL FOOD AND DRUG
ADMINISTRATION IN THE HEALTH INSURANCE LAW
.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 10-16-104, amend
(5.5)(a)(III)(B) and (21)(a) as follows:
10-16-104. Mandatory coverage provisions - definitions - rules.
(5.5) Behavioral, mental health, and substance use disorders - rules.
(a) (III) (B) A health benefit plan subject to this subsection (5.5) must
provide coverage without prior authorization for a five-day supply of at
least one of the federal food and drug administration-approved
FDA-APPROVED drugs for the treatment of opioid dependence; except that
this requirement is limited to a first request within a twelve-month period.
(21) Oral anticancer medication. (a) Any health benefit plan that
provides coverage for cancer chemotherapy treatment shall provide
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. coverage for prescribed, orally administered anticancer medication that has
been approved by the federal food and drug administration FDA and is used
to kill or slow the growth of cancerous cells. The orally administered
medication shall be provided at a cost to the covered person not to exceed
the coinsurance percentage or the copayment amount as is applied to an
intravenously administered or an injected cancer medication prescribed for
the same purpose. A medication provided pursuant to this subsection (21)
shall be prescribed only upon a finding that it is medically necessary by the
treating physician for the purpose of killing or slowing the growth of
cancerous cells in a manner that is in accordance with nationally accepted
standards of medical practice, clinically appropriate in terms of type,
frequency, extent site, and duration, and not primarily for the convenience
of the patient, physician, or other health-care provider. This subsection (21)
does not require the use of orally administered medications as a replacement
for other cancer medications. Nothing in this subsection (21) prohibits
coverage for oral generic medications in a health benefit plan. Nothing in
this subsection (21) prohibits a carrier from applying an appropriate
formulary or other clinical management to any medication described in this
subsection (21). For the purposes of this subsection (21), the treating
physician for a patient covered under a health maintenance organization's
health benefit plan shall be a physician who is designated by and affiliated
with the health maintenance organization.
SECTION 2. In Colorado Revised Statutes, 10-16-104.6, amend
(1) introductory portion as follows:
10-16-104.6. Off-label use of cancer drugs. (1) A health benefit
plan that provides coverage for prescription drugs shall not limit or exclude
coverage for any drug approved by the United States food and drug
administration FDA for use in the treatment of cancer on the basis that the
drug has not been approved by the United States food and drug
administration FDA for the treatment of the specific type of cancer for
which the drug is prescribed if:
SECTION 3. In Colorado Revised Statutes, 10-16-112.5, amend
(7)(c)(I) as follows:
10-16-112.5. Prior authorization for health-care services -
disclosures and notice - determination deadlines - criteria - limits and
exceptions - definitions - rules. (7) Definitions. As used in this section:
PAGE 2-HOUSE BILL 22-1264 (c) "Medical necessity" means a determination by the carrier that a
prudent provider would provide a particular covered health-care service to
a patient for the purpose of preventing, diagnosing, or treating an illness,
injury, disease, or symptom in a manner that is:
(I) In accordance with generally accepted standards of medical
practice and approved by the federal food and drug administration
FDA or
other required agency;
SECTION 4. In Colorado Revised Statutes, 10-16-124.7, amend
(3)(a) as follows:
10-16-124.7. Opioid analgesics with abuse-deterrent properties
- study - definitions. (3) As used in this section:
(a) "Abuse-deterrent opioid analgesic drug product" means a brand
or generic opioid analgesic drug product approved by the United States food
and drug administration FDA with abuse-deterrence labeling claims that
indicate that the drug product is expected to result in a meaningful reduction
in abuse.
SECTION 5. In Colorado Revised Statutes, 10-16-148, repeal (2)
as follows:
10-16-148. Medication-assisted treatment - limitations on
carriers - rules. (2) As used in this section, "FDA" means the food and
drug administration in the United States department of health and human
services.
SECTION 6. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly; except
that, if a referendum petition is filed pursuant to section 1 (3) of article V
of the state constitution against this act or an item, section, or part of this act
within such period, then the act, item, section, or part will not take effect
unless approved by the people at the general election to be held in
PAGE 3-HOUSE BILL 22-1264 November 2022 and, in such case, will take effect on the date of the official
declaration of the vote thereon by the governor.
____________________________ ____________________________
Alec Garnett Steve Fenberg
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Robin Jones Cindi L. Markwell
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 4-HOUSE BILL 22-1264