First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0797.01 Kristen Forrestal x4217
SENATE BILL 23-144
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING PRESCRIPTION DRUGS FOR THE TREATMENT OF CHRONIC101
PAIN.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
.)
The bill allows a health-care provider to prescribe, dispense, or
administer a schedule II, III, IV, or V controlled substance (drug) to a
patient in the course of treatment for a diagnosed condition that causes
chronic pain. The bill also clarifies that the prescribing health-care
provider is not subject to disciplinary action by the appropriate regulator
for prescribing a dosage of a drug that is equal to or more than a
SENATE SPONSORSHIP
Ginal, Marchman
HOUSE SPONSORSHIP
(None),
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. morphine milligram equivalent dosage recommendation or threshold
specified in state or federal opioid prescribing guidelines or policies.
The bill prohibits a health-care provider from refusing to accept or
continue to treat a patient solely on the basis of the dosage of a drug the
patient requires for the treatment of chronic pain. A health-care provider
is also prohibited from tapering a needed dosage solely to meet a
predetermined dosage recommendation.
The bill also prohibits a pharmacist, health insurance carrier, or
pharmacy benefit manager from refusing to fill or approve the coverage
for a drug solely on the basis of the dosage requirement of a patient.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 12-30-109.5 as2
follows:3
12-30-109.5. Prescription drugs for treatment of chronic pain4
- patients - prescribers - definitions. (1) A
S USED IN THIS SECTION,5
UNLESS THE CONTEXT OTHERWISE REQUIRES :6
(a) "C
ARRIER" HAS THE SAME MEANING AS SET FORTH IN7
10-16-102
(8).8
(b) (I) "C
HRONIC PAIN" MEANS A PAIN STATE IN WHICH THE CAUSE9
OF THE PAIN CANNOT BE REMOVED OR OTHERWISE TREATED WITH THE10
CONSENT OF THE PATIENT AND FOR WHICH , IN THE GENERALLY ACCEPTED11
COURSE OF MEDICAL PRACTICE, NO RELIEF OR CURE OF THE CAUSE OF THE12
PAIN IS POSSIBLE OR NONE HAS BEEN FOUND AFTER REASONABLE EFFORTS .13
(II) C
ONDITIONS ASSOCIATED WITH CHRONIC PAIN MAY INCLUDE ,14
BUT ARE NOT LIMITED TO, CANCER AND THE RECOVERY PERIOD , SICKLE15
CELL DISEASE, NONCANCER PAIN, RARE DISEASES, SEVERE INJURIES, AND16
HEALTH CONDITIONS REQUIRING THE PROVISION OF PALLIATIVE CARE OR17
HOSPICE CARE.18
(III) R
EASONABLE EFFORTS FOR RELIEVING OR CURING THE CAUSE19
OF THE CHRONIC PAIN MAY BE DETERMINED ON THE BASIS OF , BUT ARE NOT20
SB23-144-2- LIMITED TO, THE FOLLOWING:1
(A) W
HEN TREATING A NONTERMINALLY ILL PATIENT FOR CHRONIC2
PAIN, AN EVALUATION CONDUCTED BY THE TREATING HEALTH -CARE3
PROVIDER OR A HEALTH-CARE PROVIDER SPECIALIZING IN PAIN MEDICINE4
OR TREATMENT OF THE AREA , SYSTEM, OR ORGAN OF THE BODY5
CONFIRMED OR PERCEIVED AS THE SOURCE OF THE CHRONIC PAIN ; OR6
(B) W
HEN TREATING A TERMINALLY ILL PATIENT, AN EVALUATION7
CONDUCTED BY THE TREATING HEALTH -CARE PROVIDER WHO CONDUCTS8
THE EVALUATION IN ACCORDANCE WITH THE STANDARD OF CARE AND THE9
LEVEL OF CARE, SKILL, AND TREATMENT THAT WOULD BE RECOGNIZED BY10
A HEALTH-CARE PROVIDER UNDER SIMILAR CONDITIONS AND11
CIRCUMSTANCES.12
(c) "D
RUG DIVERSION" MEANS THE UNLAWFUL TRANSFER OF13
PRESCRIPTION DRUGS FROM A LICIT MEDICAL PURPOSE TO THE ILLICIT14
MARKETPLACE.15
(d) "H
EALTH-CARE PROVIDER" MEANS A PHYSICIAN, A PHYSICIAN16
ASSISTANT, OR AN ADVANCED PRACTICE REGISTERED NURSE LICENSED17
PURSUANT TO THIS TITLE 12.18
(e) "P
HARMACY" HAS THE SAME MEANING AS SET FORTH IN19
SECTION 12-280-103 (43).20
(f) "P
HARMACY BENEFIT MANAGER " MEANS AN ENTITY DOING21
BUSINESS IN THIS STATE THAT CONTRACTS TO ADMINISTER OR MANAGE22
PRESCRIPTION DRUG BENEFITS ON BEHALF OF ANY CARRIER THAT23
PROVIDES PRESCRIPTION DRUG BENEFITS TO RESIDENTS OF THIS STATE .24
(g) "R
ARE DISEASE" MEANS A DISEASE, DISORDER, OR CONDITION25
THAT AFFECTS FEWER THAN TWO HUNDRED THOUSAND INDIVIDUALS IN26
THE UNITED STATES AND IS CHRONIC, SERIOUS, LIFE-ALTERING, OR27
SB23-144
-3- LIFE-THREATENING.1
(h) "S
CHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE" MEANS2
A CONTROLLED SUBSTANCE AS DESCRIBED IN SECTION 18-18-204,3
18-18-205,
18-18-206, OR 18-18-207, RESPECTIVELY.4
(2) Criteria for the evaluation and treatment of chronic pain.5
W
HEN TREATING A NONTERMINALLY ILL PATIENT , THE EVALUATION OF6
THE PATIENT AND THE TREATMENT OF THE PATIENT 'S CHRONIC PAIN IS7
GOVERNED BY THE FOLLOWING CRITERIA :8
(a) A
DIAGNOSIS OF A CONDITION CAUSING CHRONIC PAIN BY THE9
TREATING HEALTH-CARE PROVIDER OR A HEALTH -CARE PROVIDER10
SPECIALIZING IN PAIN MEDICINE OR TREATMENT OF THE AREA , SYSTEM, OR11
ORGAN OF THE BODY CONFIRMED OR PERCEIVED AS THE SOURCE OF THE12
PAIN THAT IS SUFFICIENT TO MEET THE DEFINITION OF CHRONIC PAIN; AND13
(b) T
HE CAUSE OF THE DIAGNOSIS OF CHRONIC PAIN MUST NOT14
INTERFERE WITH MEDICALLY NECESSARY TREATMENT , INCLUDING BUT15
NOT LIMITED TO PRESCRIBING OR ADMINISTERING A SCHEDULE II, III, IV,16
OR V CONTROLLED SUBSTANCE.17
(3) Prescription and administration of controlled substances18
for chronic pain. (a) N
OTWITHSTANDING ANY OTHER PROVISION OF LAW ,19
A HEALTH-CARE PROVIDER MAY PRESCRIBE , DISPENSE, OR ADMINISTER A20
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE TO A PATIENT IN THE21
COURSE OF THE HEALTH-CARE PROVIDER'S TREATMENT OF THE PATIENT22
FOR A DIAGNOSED CONDITION CAUSING CHRONIC PAIN . A HEALTH-CARE23
PROVIDER IS NOT SUBJECT TO DISCIPLINARY ACTION BY THE REGULATOR24
FOR APPROPRIATELY PRESCRIBING , DISPENSING, OR ADMINISTERING A25
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE IN THE COURSE OF26
TREATMENT OF A PATIENT FOR CHRONIC PAIN IF THE HEALTH -CARE27
SB23-144
-4- PROVIDER KEEPS ACCURATE RECORDS OF THE PURPOSE , USE,1
PRESCRIPTION, AND DISPOSAL OF THE CONTROLLED SUBSTANCE , WRITES2
ACCURATE PRESCRIPTIONS , AND PRESCRIBES MEDICATIONS IN3
ACCORDANCE WITH THE CURRENT STANDARD OF CARE .4
(b) A
HEALTH-CARE PROVIDER ACTING IN GOOD FAITH AND BASED5
ON THE NEEDS OF THE PATIENT WITH A DIAGNOSED CONDITION CAUSING6
CHRONIC PAIN IS NOT SUBJECT TO DISCIPLINE FROM THE REGULATOR7
SOLELY FOR PRESCRIBING A DOSAGE THAT EQUATES TO AN UPWARD8
DEVIATION FROM MORPHINE MILLIGRAM EQUIVALENT DOSAGE9
RECOMMENDATIONS OR FROM THRESHOLDS SPECIFIED IN STATE OR10
FEDERAL OPIOID PRESCRIBING GUIDELINES OR POLICIES .11
(c) A
HEALTH-CARE PROVIDER SHALL NOT REFUSE TO ACCEPT A12
NEW PATIENT OR REFUSE TO CONTINUE TO TREAT A CURRENT PATIENT13
SOLELY ON THE BASIS OF THE MORPHINE MILLIGRAM EQUIVALENT DOSAGE14
THAT THE PATIENT REQUIRES FOR THE TREATMENT OF CHRONIC PAIN .15
(d) A
HEALTH-CARE PROVIDER TREATING CHRONIC PAIN BY16
PRESCRIBING, DISPENSING, OR ADMINISTERING A SCHEDULE II, III, IV, OR17
V
CONTROLLED SUBSTANCE THAT INCLUDES BUT IS NOT LIMITED TO OPIOID18
ANALGESICS MUST NOT TAPER A PATIENT 'S MEDICATION DOSAGE SOLELY19
TO MEET A PREDETERMINED MORPHINE MILLIGRAM EQUIVALENT DOSAGE20
RECOMMENDATION OR THRESHOLD IF THE PATIENT IS STABLE AND21
COMPLIANT WITH THE TREATMENT PLAN AND IS NOT EXPERIENCING22
SERIOUS HARM FROM THE LEVEL OF MEDICATION CURRENTLY BEING23
PRESCRIBED OR PREVIOUSLY PRESCRIBED .24
(e) A
HEALTH-CARE PROVIDER'S DECISION TO TAPER A PATIENT'S25
MEDICATION DOSAGE MUST BE BASED ON FACTORS OTHER THAN A26
MORPHINE MILLIGRAM EQUIVALENT DOSAGE RECOMMENDATION OR27
SB23-144
-5- THRESHOLD.1
(f) A
PHARMACIST, CARRIER, OR PHARMACY BENEFIT MANAGER2
SHALL NOT REFUSE TO FILL A PRESCRIPTION FOR AN OPIATE ISSUED BY A3
HEALTH-CARE PROVIDER WITH THE AUTHORITY TO PRESCRIBE OPIATES4
SOLELY BECAUSE THE PRESCRIPTION ORDER EXCEEDS A PREDETERMINED5
MORPHINE MILLIGRAM EQUIVALENT DOSAGE RECOMMENDATION OR6
THRESHOLD.7
(g) B
EFORE TREATING A PATIENT FOR CHRONIC PAIN IN8
ACCORDANCE WITH THIS SUBSECTION (3), A HEALTH-CARE PROVIDER9
SHALL DISCUSS WITH THE PATIENT OR THE PATIENT'S LEGAL GUARDIAN, IF10
APPLICABLE, THE RISKS ASSOCIATED WITH THE SCHEDULE II, III, IV, OR V11
CONTROLLED SUBSTANCE TO BE PRESCRIBED OR ADMINISTERED IN THE12
COURSE OF THE HEALTH-CARE PROVIDER'S TREATMENT OF THE PATIENT13
AND DOCUMENT THE DISCUSSION IN THE PATIENT 'S RECORD.14
(4) Limits on applicability. T
HIS SECTION DOES NOT APPLY TO:15
(a) A
HEALTH-CARE PROVIDER'S TREATMENT OF A PATIENT FOR A16
SUBSTANCE USE DISORDER RESULTING FROM THE USE OF A SCHEDULE II,17
III,
IV, OR V CONTROLLED SUBSTANCE;18
(b) T
HE PRESCRIPTION OR ADMINISTRATION OF A SCHEDULE II, III,19
IV,
OR V CONTROLLED SUBSTANCE TO A PATIENT WHOM THE20
HEALTH-CARE PROVIDER KNOWS TO BE USING THE CONTROLLED21
SUBSTANCE FOR NONTHERAPEUTIC OR DRUG DIVERSION PURPOSES ;22
(c) T
HE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A23
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE FOR THE PURPOSE OF24
TERMINATING THE LIFE OF A PATIENT WITH CHRONIC PAIN ; OR25
(d) T
HE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A26
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE THAT IS NOT A27
SB23-144
-6- CONTROLLED SUBSTANCE APPROVED BY THE FEDERAL FOOD AND DRUG1
ADMINISTRATION FOR PAIN RELIEF.2
SECTION 2. Safety clause. The general assembly hereby finds,3
determines, and declares that this act is necessary for the immediate4
preservation of the public peace, health, or safety.5
SB23-144
-7-