Colorado 2022 Regular Session

Colorado House Bill HB1264 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	Second Regular Session
	2	+	Seventy-third General Assembly
	3	+	STATE OF COLORADO
	4	+	REREVISED
	5	+	This Version Includes All Amendments
	6	+	Adopted in the Second House
	7	+	LLS NO. 22-0786.01 Christy Chase x2008
1	8		HOUSE BILL 22-1264
2		-	~~BY REPRESENTATIVE(S) Valdez D. and Woodrow, Lynch, Pico,~~
3		-	~~Boesenecker~~, ~~Esgar~~, ~~Exum, Jodeh,~~ ~~Snyder;~~
4		-	~~also SENATOR(S) Moreno and Woodward, Kirkmeyer, Zenzinger, Priola.~~
	9	+	House Committees Senate Committees
	10	+	Agriculture, Livestock, & Water Health & Human Services
	11	+	A BILL FOR AN ACT
5	12		C
6		-	ONCERNING UPDATING REFERENCES TO THE FEDERAL FOOD AND DRUG
7		-	ADMINISTRATION IN THE HEALTH INSURANCE LAW
8		-	.
9		-
10		-	Be it enacted by the General Assembly of the State of Colorado:
11		-	SECTION 1. In Colorado Revised Statutes, 10-16-104, amend
12		-	(5.5)(a)(III)(B) and (21)(a) as follows:
13		-	10-16-104. Mandatory coverage provisions - definitions - rules.
14		-	(5.5) Behavioral, mental health, and substance use disorders - rules.
15		-	(a) (III) (B) A health benefit plan subject to this subsection (5.5) must
16		-	provide coverage without prior authorization for a five-day supply of at
17		-	least one of the federal food and drug administration-approved
18		-	FDA-APPROVED drugs for the treatment of opioid dependence; except that
19		-	this requirement is limited to a first request within a twelve-month period.
20		-	(21) Oral anticancer medication. (a) Any health benefit plan that
21		-	provides coverage for cancer chemotherapy treatment shall provide
22		-	NOTE: This bill has been prepared for the signatures of the appropriate legislative
23		-	officers and the Governor. To determine whether the Governor has signed the bill
24		-	or taken other action on it, please consult the legislative status sheet, the legislative
25		-	history, or the Session Laws.
26		-	________
27		-	Capital letters or bold & italic numbers indicate new material added to existing law; dashes
28		-	through words or numbers indicate deletions from existing law and such material is not part of
29		-	the act. coverage for prescribed, orally administered anticancer medication that has
30		-	been approved by the federal food and drug administration FDA and is used
31		-	to kill or slow the growth of cancerous cells. The orally administered
32		-	medication shall be provided at a cost to the covered person not to exceed
33		-	the coinsurance percentage or the copayment amount as is applied to an
34		-	intravenously administered or an injected cancer medication prescribed for
35		-	the same purpose. A medication provided pursuant to this subsection (21)
36		-	shall be prescribed only upon a finding that it is medically necessary by the
37		-	treating physician for the purpose of killing or slowing the growth of
38		-	cancerous cells in a manner that is in accordance with nationally accepted
39		-	standards of medical practice, clinically appropriate in terms of type,
40		-	frequency, extent site, and duration, and not primarily for the convenience
41		-	of the patient, physician, or other health-care provider. This subsection (21)
42		-	does not require the use of orally administered medications as a replacement
43		-	for other cancer medications. Nothing in this subsection (21) prohibits
44		-	coverage for oral generic medications in a health benefit plan. Nothing in
45		-	this subsection (21) prohibits a carrier from applying an appropriate
46		-	formulary or other clinical management to any medication described in this
47		-	subsection (21). For the purposes of this subsection (21), the treating
48		-	physician for a patient covered under a health maintenance organization's
49		-	health benefit plan shall be a physician who is designated by and affiliated
50		-	with the health maintenance organization.
51		-	SECTION 2. In Colorado Revised Statutes, 10-16-104.6, amend
52		-	(1) introductory portion as follows:
53		-	10-16-104.6. Off-label use of cancer drugs. (1) A health benefit
54		-	plan that provides coverage for prescription drugs shall not limit or exclude
55		-	coverage for any drug approved by the United States food and drug
56		-	administration FDA for use in the treatment of cancer on the basis that the
57		-	drug has not been approved by the United States food and drug
58		-	administration FDA for the treatment of the specific type of cancer for
59		-	which the drug is prescribed if:
60		-	SECTION 3. In Colorado Revised Statutes, 10-16-112.5, amend
61		-	(7)(c)(I) as follows:
62		-	10-16-112.5. Prior authorization for health-care services -
63		-	disclosures and notice - determination deadlines - criteria - limits and
64		-	exceptions - definitions - rules. (7) Definitions. As used in this section:
65		-	PAGE 2-HOUSE BILL 22-1264 (c) "Medical necessity" means a determination by the carrier that a
66		-	prudent provider would provide a particular covered health-care service to
67		-	a patient for the purpose of preventing, diagnosing, or treating an illness,
68		-	injury, disease, or symptom in a manner that is:
69		-	(I) In accordance with generally accepted standards of medical
70		-	practice and approved by the federal food and drug administration
71		-	FDA or
72		-	other required agency;
73		-	SECTION 4. In Colorado Revised Statutes, 10-16-124.7, amend
74		-	(3)(a) as follows:
75		-	10-16-124.7. Opioid analgesics with abuse-deterrent properties
76		-	- study - definitions. (3) As used in this section:
77		-	(a) "Abuse-deterrent opioid analgesic drug product" means a brand
78		-	or generic opioid analgesic drug product approved by the United States food
79		-	and drug administration FDA with abuse-deterrence labeling claims that
80		-	indicate that the drug product is expected to result in a meaningful reduction
81		-	in abuse.
82		-	SECTION 5. In Colorado Revised Statutes, 10-16-148, repeal (2)
83		-	as follows:
84		-	10-16-148. Medication-assisted treatment - limitations on
85		-	carriers - rules. (2) As used in this section, "FDA" means the food and
86		-	drug administration in the United States department of health and human
87		-	services.
88		-	SECTION 6. Act subject to petition - effective date. This act
89		-	takes effect at 12:01 a.m. on the day following the expiration of the
90		-	ninety-day period after final adjournment of the general assembly; except
91		-	that, if a referendum petition is filed pursuant to section 1 (3) of article V
92		-	of the state constitution against this act or an item, section, or part of this act
93		-	within such period, then the act, item, section, or part will not take effect
94		-	unless approved by the people at the general election to be held in
95		-	PAGE 3-HOUSE BILL 22-1264 November 2022 and, in such case, will take effect on the date of the official
96		-	declaration of the vote thereon by the governor.
97		-	____________________________ ____________________________
98		-	Alec Garnett Steve Fenberg
99		-	SPEAKER OF THE HOUSE PRESIDENT OF
100		-	OF REPRESENTATIVES THE SENATE
101		-	____________________________ ____________________________
102		-	Robin Jones Cindi L. Markwell
103		-	CHIEF CLERK OF THE HOUSE SECRETARY OF
104		-	OF REPRESENTATIVES THE SENATE
105		-	APPROVED________________________________________
106		-	(Date and Time)
107		-	_________________________________________
108		-	Jared S. Polis
109		-	GOVERNOR OF THE STATE OF COLORADO
110		-	PAGE 4-HOUSE BILL 22-1264
	13	+	ONCERNING UPDATING REFERENCE S TO THE FEDERAL FOOD AND101
	14	+	DRUG ADMINISTRATION IN TH E HEALTH INSURANCE LAW .102
	15	+	Bill Summary
	16	+	(Note: This summary applies to this bill as introduced and does
	17	+	not reflect any amendments that may be subsequently adopted. If this bill
	18	+	passes third reading in the house of introduction, a bill summary that
	19	+	applies to the reengrossed version of this bill will be available at
	20	+	http://leg.colorado.gov/
	21	+	.)
	22	+	Statutory Revision Committee. The bill strikes references to the
	23	+	federal food and drug administration in the health insurance code and
	24	+	replaces the references with the term "FDA", which is defined for the
	25	+	entire code to mean the federal food and drug administration.
	26	+	SENATE
	27	+	3rd Reading Unamended
	28	+	April 7, 2022
	29	+	SENATE
	30	+	2nd Reading Unamended
	31	+	April 6, 2022
	32	+	HOUSE
	33	+	3rd Reading Unamended
	34	+	March 17, 2022
	35	+	HOUSE
	36	+	2nd Reading Unamended
	37	+	March 16, 2022
	38	+	HOUSE SPONSORSHIP
	39	+	Valdez D. and Woodrow, Lynch, Pico, Boesenecker, Esgar, Exum, Jodeh, Snyder
	40	+	SENATE SPONSORSHIP
	41	+	Moreno and Woodward, Kirkmeyer, Zenzinger, Priola
	42	+	Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
	43	+	Capital letters or bold & italic numbers indicate new material to be added to existing statute.
	44	+	Dashes through the words indicate deletions from existing statute. Be it enacted by the General Assembly of the State of Colorado:1
	45	+	SECTION 1. In Colorado Revised Statutes, 10-16-104, amend2
	46	+	(5.5)(a)(III)(B) and (21)(a) as follows:3
	47	+	10-16-104. Mandatory coverage provisions - definitions -4
	48	+	rules. (5.5) Behavioral, mental health, and substance use disorders5
	49	+	- rules. (a) (III) (B) A health benefit plan subject to this subsection (5.5)6
	50	+	must provide coverage without prior authorization for a five-day supply7
	51	+	of at least one of the federal food and drug administration-approved8
	52	+	FDA-
	53	+	APPROVED drugs for the treatment of opioid dependence; except that9
	54	+	this requirement is limited to a first request within a twelve-month period.10
	55	+	(21) Oral anticancer medication. (a) Any health benefit plan11
	56	+	that provides coverage for cancer chemotherapy treatment shall provide12
	57	+	coverage for prescribed, orally administered anticancer medication that13
	58	+	has been approved by the federal food and drug administration
	59	+	FDA and14
	60	+	is used to kill or slow the growth of cancerous cells. The orally15
	61	+	administered medication shall be provided at a cost to the covered person16
	62	+	not to exceed the coinsurance percentage or the copayment amount as is17
	63	+	applied to an intravenously administered or an injected cancer medication18
	64	+	prescribed for the same purpose. A medication provided pursuant to this19
	65	+	subsection (21) shall be prescribed only upon a finding that it is medically20
	66	+	necessary by the treating physician for the purpose of killing or slowing21
	67	+	the growth of cancerous cells in a manner that is in accordance with22
	68	+	nationally accepted standards of medical practice, clinically appropriate23
	69	+	in terms of type, frequency, extent site, and duration, and not primarily for24
	70	+	the convenience of the patient, physician, or other health-care provider.25
	71	+	This subsection (21) does not require the use of orally administered26
	72	+	medications as a replacement for other cancer medications. Nothing in27
	73	+	1264
	74	+	-2- this subsection (21) prohibits coverage for oral generic medications in a1
	75	+	health benefit plan. Nothing in this subsection (21) prohibits a carrier2
	76	+	from applying an appropriate formulary or other clinical management to3
	77	+	any medication described in this subsection (21). For the purposes of this4
	78	+	subsection (21), the treating physician for a patient covered under a health5
	79	+	maintenance organization's health benefit plan shall be a physician who6
	80	+	is designated by and affiliated with the health maintenance organization.7
	81	+	SECTION 2. In Colorado Revised Statutes, 10-16-104.6, amend8
	82	+	(1) introductory portion as follows:9
	83	+	10-16-104.6. Off-label use of cancer drugs. (1) A health benefit10
	84	+	plan that provides coverage for prescription drugs shall not limit or11
	85	+	exclude coverage for any drug approved by the United States food and12
	86	+	drug administration FDA for use in the treatment of cancer on the basis13
	87	+	that the drug has not been approved by the United States food and drug14
	88	+	administration FDA for the treatment of the specific type of cancer for15
	89	+	which the drug is prescribed if:16
	90	+	SECTION 3. In Colorado Revised Statutes, 10-16-112.5, amend17
	91	+	(7)(c)(I) as follows:18
	92	+	10-16-112.5. Prior authorization for health-care services -19
	93	+	disclosures and notice - determination deadlines - criteria - limits and20
	94	+	exceptions - definitions - rules. (7) Definitions. As used in this section:21
	95	+	(c) "Medical necessity" means a determination by the carrier that22
	96	+	a prudent provider would provide a particular covered health-care service23
	97	+	to a patient for the purpose of preventing, diagnosing, or treating an24
	98	+	illness, injury, disease, or symptom in a manner that is:25
	99	+	(I) In accordance with generally accepted standards of medical26
	100	+	practice and approved by the federal food and drug administration FDA27
	101	+	1264
	102	+	-3- or other required agency;1
	103	+	SECTION 4. In Colorado Revised Statutes, 10-16-124.7, amend2
	104	+	(3)(a) as follows:3
	105	+	10-16-124.7. Opioid analgesics with abuse-deterrent4
	106	+	properties - study - definitions. (3) As used in this section:5
	107	+	(a) "Abuse-deterrent opioid analgesic drug product" means a6
	108	+	brand or generic opioid analgesic drug product approved by the United7
	109	+	States food and drug administration FDA with abuse-deterrence labeling8
	110	+	claims that indicate that the drug product is expected to result in a9
	111	+	meaningful reduction in abuse.10
	112	+	SECTION 5. In Colorado Revised Statutes, 10-16-148, repeal (2)11
	113	+	as follows:12
	114	+	10-16-148. Medication-assisted treatment - limitations on13
	115	+	carriers - rules. (2) As used in this section, "FDA" means the food and14
	116	+	drug administration in the United States department of health and human15
	117	+	services.16
	118	+	SECTION 6. Act subject to petition - effective date. This act17
	119	+	takes effect at 12:01 a.m. on the day following the expiration of the18
	120	+	ninety-day period after final adjournment of the general assembly; except19
	121	+	that, if a referendum petition is filed pursuant to section 1 (3) of article V20
	122	+	of the state constitution against this act or an item, section, or part of this21
	123	+	act within such period, then the act, item, section, or part will not take22
	124	+	effect unless approved by the people at the general election to be held in23
	125	+	November 2022 and, in such case, will take effect on the date of the24
	126	+	official declaration of the vote thereon by the governor.25
	127	+	1264
	128	+	-4-