First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
ENGROSSED
This Version Includes All Amendments Adopted
on Second Reading in the House of Introduction
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
Amended 2nd Reading
March 7, 2023
SENATE SPONSORSHIP
Ginal, Marchman
HOUSE SPONSORSHIP
Mabrey,
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 THAT TYPICALLY LASTS
9
THREE MONTHS OR LONGER AND MAY BE THE RESULT OF AN UNDERLYING10
MEDICAL DISEASE OR CONDITION , INJURY, MEDICAL TREATMENT ,11
INFLAMMATION, OR UNKNOWN CAUSE. "CHRONIC PAIN" IS A PAIN STATE12
IN WHICH THE CAUSE OF THE PAIN OFTEN CANNOT BE REMOVED WITH13
REASONABLE MEDICAL EFFORTS AT THE CONSENT OF THE PATIENT , OR PAIN14
FOR WHICH NO CURE CAN BE FOUND AFTER REASONABLE MEDICAL15
EFFORTS. CHRONIC PAIN MAY RESTRICT THE ABILITY OF INDIVIDUALS TO16
WORK, CARE FOR THEMSELVES, AND ENGAGE IN BASIC LIFE, SOCIAL, AND17
PHYSICAL ACTIVITIES.18
(II) C
ONDITIONS ASSOCIATED WITH CHRONIC PAIN MAY INCLUDE ,19
BUT ARE NOT LIMITED TO, CANCER AND THE RECOVERY PERIOD , SICKLE20
144-2- CELL DISEASE, NONCANCER PAIN, RARE DISEASES, SEVERE INJURIES, AND1
HEALTH CONDITIONS REQUIRING THE PROVISION OF PALLIATIVE CARE OR2
HOSPICE CARE.3
(III) R
EASONABLE EFFORTS FOR RELIEVING OR CURING THE CAUSE4
OF THE CHRONIC PAIN MAY BE DETERMINED ON THE BASIS OF , BUT ARE NOT5
LIMITED TO, THE FOLLOWING:6
(A) W
HEN TREATING A NONTERMINALLY ILL PATIENT FOR CHRONIC7
PAIN, AN EVALUATION CONDUCTED BY THE TREATING HEALTH -CARE8
PROVIDER OR A HEALTH-CARE PROVIDER SPECIALIZING IN PAIN MEDICINE9
OR TREATMENT OF THE AREA , SYSTEM, OR ORGAN OF THE BODY10
CONFIRMED OR PERCEIVED AS THE SOURCE OF THE CHRONIC PAIN ; OR11
(B) W
HEN TREATING A TERMINALLY ILL PATIENT, AN EVALUATION12
CONDUCTED BY THE TREATING HEALTH -CARE PROVIDER WHO CONDUCTS13
THE EVALUATION IN ACCORDANCE WITH THE STANDARD OF CARE AND THE14
LEVEL OF CARE, SKILL, AND TREATMENT THAT WOULD BE RECOGNIZED BY15
A HEALTH-CARE PROVIDER UNDER SIMILAR CONDITIONS AND16
CIRCUMSTANCES.17
(c) "D
RUG DIVERSION" MEANS THE UNLAWFUL TRANSFER OF18
PRESCRIPTION DRUGS FROM A LICIT MEDICAL PURPOSE TO THE ILLICIT19
MARKETPLACE.20
(d) "H
EALTH-CARE PROVIDER" MEANS A PHYSICIAN, A PHYSICIAN21
ASSISTANT, OR AN ADVANCED PRACTICE REGISTERED NURSE LICENSED22
PURSUANT TO THIS TITLE 12.23
24
(e) "RARE 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
144
-3- LIFE-THREATENING.1
(f) "SCHEDULE 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
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 LEGITIMATE MEDICAL PURPOSE IN THE USUAL COURSE 4
OF PROFESSIONAL PRACTICE.5
(b) A
HEALTH-CARE PROVIDER ACTING IN GOOD FAITH AND BASED6
ON THE NEEDS OF THE PATIENT WITH A DIAGNOSED CONDITION CAUSING7
CHRONIC PAIN IS NOT SUBJECT TO DISCIPLINE FROM THE REGULATOR8
SOLELY FOR PRESCRIBING A DOSAGE THAT EQUATES TO AN UPWARD9
DEVIATION FROM MORPHINE MILLIGRAM EQUIVALENT DOSAGE10
RECOMMENDATIONS OR FROM THRESHOLDS SPECIFIED IN STATE OR11
FEDERAL OPIOID PRESCRIBING GUIDELINES OR POLICIES .12
13
(c) A
HEALTH-CARE PROVIDER TREATING A PATIENT WITH CHRONIC
14
PAIN BY PRESCRIBING, DISPENSING, OR ADMINISTERING ONE OR MORE15
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCES THAT INCLUDE , BUT16
ARE NOT LIMITED TO, OPIOID ANALGESICS SHALL NOT BE REQUIRED TO17
TAPER A PATIENT 'S MEDICATION DOSAGE SOLELY TO MEET A18
PREDETERMINED MORPHINE MILLIGRAM EQUIVALENT DOSAGE19
RECOMMENDATION OR THRESHOLD IF THE PATIENT IS STABLE AND20
COMPLIANT WITH THE TREATMENT PLAN AND IS NOT EXPERIENCING21
SERIOUS HARM FROM THE LEVEL OF MEDICATION CURRENTLY BEING22
PRESCRIBED OR PREVIOUSLY PRESCRIBED . A DECISION TO TAPER OR23
MAINTAIN MEDICATION MUST INCLUDE AN INDIVIDUALIZED ASSESSMENT24
OF THE PATIENT'S CURRENT MEDICAL CONDITION AND TREATMENT PLAN ,25
THE RISKS AND BENEFITS OF MAINTAINING OR TAPERING THE PATIENT 'S26
MEDICATION, AND A DISCUSSION WITH THE PATIENT.27
144
-5- (d) (I) A PHARMACY, CARRIER, OR PHARMACY BENEFIT MANAGER1
SHALL NOT HAVE A POLICY IN PLACE THAT REQUIRES THE PHARMACIST TO2
REFUSE TO FILL A PRESCRIPTION FOR AN OPIATE ISSUED BY A HEALTH-CARE3
PROVIDER WITH THE AUTHORITY TO PRESCRIBE OPIATES SOLELY BECAUSE4
THE PRESCRIPTION IS FOR AN OPIATE OR BECAUSE THE PRESCRIPTION5
ORDER EXCEEDS A PREDETERMINED MORPHINE MILLIGRAM EQUIVALENT6
DOSAGE RECOMMENDATION OR THRESHOLD .7
(II) A
HEALTH-CARE PRACTICE OR CLINIC IN WHICH A
8
HEALTH-CARE PROVIDER IS AUTHORIZED TO PRESCRIBE SCHEDULE II, III,9
IV,
OR V CONTROLLED SUBSTANCES SHALL NOT HAVE A POLICY IN PLACE
10
THAT REQUIRES THE HEALTH-CARE PROVIDER TO REFUSE TO PRESCRIBE ,11
ADMINISTER, OR DISPENSE A PRESCRIPTION FOR AN OPIATE SOLELY12
BECAUSE THE PRESCRIPTION EXCEEDS A PREDETERMINED MORPHINE13
MILLIGRAM EQUIVALENT DOSAGE RECOMMENDATION OR THRESHOLD .14
(e) BEFORE TREATING A PATIENT FOR CHRONIC PAIN IN15
ACCORDANCE WITH THIS SUBSECTION (3), A HEALTH-CARE PROVIDER16
SHALL DISCUSS WITH THE PATIENT OR THE PATIENT'S LEGAL GUARDIAN, IF17
APPLICABLE, THE RISKS ASSOCIATED WITH THE SCHEDULE II, III, IV, OR V18
CONTROLLED SUBSTANCE TO BE PRESCRIBED OR ADMINISTERED IN THE19
COURSE OF THE HEALTH-CARE PROVIDER'S TREATMENT OF THE PATIENT20
AND DOCUMENT THE DISCUSSION IN THE PATIENT 'S RECORD.21
(4) Limits on applicability. T
HIS SECTION DOES NOT APPLY TO:22
(a) A
HEALTH-CARE PROVIDER'S TREATMENT OF A PATIENT FOR A23
SUBSTANCE USE DISORDER RESULTING FROM THE USE OF A SCHEDULE II,24
III,
IV, OR V CONTROLLED SUBSTANCE;25
(b) T
HE PRESCRIPTION OR ADMINISTRATION OF A SCHEDULE II, III,26
IV,
OR V CONTROLLED SUBSTANCE TO A PATIENT WHOM THE27
144
-6- HEALTH-CARE PROVIDER KNOWS TO BE USING THE CONTROLLED1
SUBSTANCE FOR NONTHERAPEUTIC OR DRUG DIVERSION PURPOSES ;2
(c) T
HE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A3
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE FOR THE PURPOSE OF4
TERMINATING THE LIFE OF A PATIENT WITH CHRONIC PAIN ; OR5
(d) T
HE PRESCRIPTION, DISPENSING, OR ADMINISTRATION OF A6
SCHEDULE II, III, IV, OR V CONTROLLED SUBSTANCE THAT IS NOT A7
CONTROLLED SUBSTANCE APPROVED BY THE FEDERAL FOOD AND DRUG8
ADMINISTRATION FOR PAIN RELIEF.9
SECTION 2. Safety clause. The general assembly hereby finds,10
determines, and declares that this act is necessary for the immediate11
preservation of the public peace, health, or safety.12
144
-7-