reglab/statecodes huggingface dataset:
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-422 - [Effective Until 8/7/2024] Medication-assisted treatment - limitations on MCEs - definition

(1)
As used in this section, "FDA" means the food and drug administration in the United States department of health and human services.
(2)
Notwithstanding any provision of law to the contrary, beginning January 1, 2020, each MCE that provides prescription drug benefits for the treatment of substance use disorders shall:
(a)
Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;
(b)
Not impose any step therapy requirements as a prerequisite to authorizing coverage for a prescription medication approved by the FDA for the treatment of substance use disorders; and
(c)
Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered.
Added by 2019 Ch. 195, § 15, eff. 5/16/2019.
L. 2019: Entire section added, (HB 19-1269), ch. 2136, p. 2136, § 15, effective May 16.
Section 17(1) of chapter 195 (HB 19-1269), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 16, 2019.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-422 - [Effective 8/7/2024] Medication-assisted treatment - limitations on MCEs - definition

(1)
As used in this section, "FDA" means the food and drug administration in the United States department of health and human services.
(2)
Notwithstanding any provision of law to the contrary, each MCE that provides prescription drug benefits or methadone administration for the treatment of substance use disorders shall:
(a)
Not impose any prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders, regardless of the dosage amount;
(b)
Not impose any step therapy requirements as a prerequisite to authorizing coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;
(c)
Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered; and
(d)
Set the reimbursement rate for take-home methadone treatment and office-administered methadone treatment at the same rate.
Amended by 2024 Ch. 470,§ 21, eff. 8/7/2024.
Added by 2019 Ch. 195, § 15, eff. 5/16/2019.
L. 2019: Entire section added, (HB 19-1269), ch. 2136, p. 2136, § 15, effective May 16.
Section 17(1) of chapter 195 (HB 19-1269), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 16, 2019.
2024 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-423 - Independent review organization - review denial of residential and inpatient substance use disorder treatment claims - contract

No later than July 1, 2023, the state department shall contract with one or more independent review organizations to conduct external medical reviews requested for review by a medicaid provider when there is a denial or reduction for residential or inpatient substance use disorder treatment and medicaid appeals processes have been exhausted.
Added by 2021 Ch. 362,§9, eff. 6/28/2021.
L. 2021: Entire section added, (SB 21-137), ch. 2364, p. 2364, § 9, effective June 28.
For the short title ("Behavioral Health Recovery Act of 2021") and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-424 - Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report

(1)
On or before October 1, 2021, the state department shall consult with the behavioral health administration in the department of human services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment. The processes must incorporate the version of "The ASAM Criteria" used by the state department and align with federal medicaid payment requirements.
(2)
On or before January 1, 2022, the state department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts, and each MCE shall adhere to the standards when conducting utilization management for residential and inpatient substance use disorder treatment.
(3)
On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the version of "The ASAM Criteria" used by the state department was considered when determining medical necessity.
(4)
(a)
Beginning July 1, 2024, and quarterly thereafter, the state department shall report on the residential and inpatient substance use disorder utilization management statistics on the state department's website.
(b)
(c)
Any information reported pursuant to subsection (4)(a) of this section may be aggregated as necessary to ensure confidentiality pursuant to 42 CFR part 2.
Amended by 2024 Ch. 34,§ 25, eff. 3/22/2024.
Amended by 2022 Ch. 222, § 76, eff. 7/1/2022.
Added by 2021 Ch. 362, § 10, eff. 6/28/2021.
L. 2021: Entire section added, (SB 21-137), ch. 2365, p. 2365, § 10, effective June 28.
For the short title ("Behavioral Health Recovery Act of 2021") and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-425 - Audit of MCE denials for residential and inpatient substance use disorder treatment authorization - report

(1)
No later than July 1, 2022, the state department shall contract with an independent third-party vendor to audit thirty-three percent of all denials of authorization for inpatient and residential substance use disorder treatment for each MCE.
(2)
Beginning no later than January 31, 2025, and no later than each January 31 thereafter, the state department shall submit the results of the audit conducted pursuant to subsection (1) of this section and any recommended changes to the residential and inpatient substance use disorder benefit to the house of representatives health and human services committee, the senate health and human services committee, or their successor committees, and the joint budget committee.
Amended by 2024 Ch. 34,§ 26, eff. 3/22/2024.
Added by 2021 Ch. 362, § 11, eff. 6/28/2021.
L. 2021: Entire section added, (SB 21-137), ch. 2366, p. 2366, § 11, effective June 28.
For the short title ("Behavioral Health Recovery Act of 2021") and the legislative declaration in SB 21-137, see sections 1 and 2 of chapter 362, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 4 - STATEWIDE MANAGED CARE SYSTEM (§§ 25.5-5-401 — 25.5-5-427) › Section 25.5-5-427 - [Effective 8/7/2024] Managed care entities - behavioral health providers - disclosure of reimbursement rates

(1)
The state department shall require each MCE that contracts with the state department to disclose the aggregated average and lowest rates of reimbursement for a set of behavioral health services determined by the state department.
(2)
Behavioral health providers are authorized to disclose the reimbursement rates paid by an MCE to the behavioral health provider.
Added by 2024 Ch. 470,§ 23, eff. 8/7/2024.
2024 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-500.3 - Authorization to bill third party

As a condition of doing business in the state, each provider is deemed to authorize the state department, or an independent contractor retained by the state department, to bill a third party, as defined in section
25.5-4-209 (2)(g)(II)
, on behalf of the provider if the third party is determined to be liable to pay for care pursuant to sections
25.5-4-209
and
25.5-4-300.4
.
L. 2010: Entire section added, (SB 10 -167), ch. 296, p. 1379, § 9, effective May 26.
For the legislative declaration in SB 10-167, see section 1 of chapter 296, Session Laws of Colorado 2010.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-501 - Providers - drug reimbursement

(1)
(a)
As to drugs for which payment is made, the state board's rules for payment must include the requirement that the generic equivalent of a brand-name drug be prescribed if the generic equivalent is a therapeutic equivalent to the brand-name drug, except when reimbursement to the state for a brand-name drug makes the brand-name drug less expensive than the cost of the generic equivalent. The state department shall grant an exception to this requirement if the patient has been stabilized on a medication and the treating physician, or a pharmacist with the concurrence of the treating physician, is of the opinion that a transition to the generic equivalent of the brand-name drug would be unacceptably disruptive. The requirements of this subsection (1) do not apply to medications for the treatment of behavioral or mental health disorders, cancer, epilepsy, or human immunodeficiency virus and acquired immune deficiency syndrome.
(b)
The provisions of this subsection (1) shall apply to fee-for-service and primary care physician program recipients.
(2)
It is the general assembly's intent that requiring the use of a generic equivalent of a brand-name drug will produce savings within the state's medicaid program. The state department, therefore, is authorized to use savings in the medical services premiums appropriations to fund the administrative review process required by subsection (1) of this section.
Amended by 2017 Ch. 263,§ 205, eff. 5/25/2017.
Amended by 2013 Ch. 217,§ 63, eff. 5/13/2013.
L. 2006: Entire article added with relocations, p. 1904, § 7, effective July 1. L. 2013: (1)(a) amended, (HB 13-1266), ch. 217, p. 992, § 63, effective May 13. L. 2017: (1)(a) amended, (SB 17-242), ch. 263, p. 1329, § 205, effective May 25.
This section is similar to former § 26-4-406 as it existed prior to 2006.
For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-502 - Unused medications - reuse - rules - definition

(1)
As used in this section, unless the context otherwise requires, "medication" means prescription medication that is not a controlled substance.
(2)
A pharmacist participating in the medical assistance program may accept unused medication from a licensed facility, as defined in section
12-280-135(1)(b)
, or a licensed health-care provider for the purpose of dispensing the medication to another person. A pharmacist shall reimburse the state department for the cost of medications that the state department has paid to the pharmacist if medications are returned to a pharmacist and the medications are available to be dispensed to another person. Medications shall only be available to be dispensed to another person under this section if the medications are:
(a)
Liquid and the vial is still sealed and properly stored;
(b)
Individually packaged and the packaging has not been damaged; or
(c)
In the original, unopened, sealed, and tamper-evident unit dose packaging.
(3)
Medication dispensed pursuant to this section shall bear an expiration date that is later than six months after the date the drug was donated.
(4)
Any savings realized through reimbursements received pursuant to subsection (2) of this section shall fund the administration of this section.
(5)
The state board, in consultation with the state board of pharmacy, shall adopt rules for the implementation of this section.
Amended by 2021 Ch. 423,§24, eff. 7/2/2021.
Amended by 2019 Ch. 136,§186, eff. 10/1/2019.
L. 2006: Entire article added with relocations, p. 1904, § 7, effective July 1. L. 2012: IP(2) amended, (HB 12-1311), ch. 1621, p. 1621, § 76, effective July 1. L. 2019: IP(2) amended, (HB 19-1172), ch. 1710, p. 1710, § 186, effective October 1. L. 2021: (4) amended, (SB 21-266), ch. 2803, p. 2803, § 24, effective July 2.
This section is similar to former § 26-4-406.3 as it existed prior to 2006.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-503 - [Effective Until 8/7/2024] Prescription drug benefits - authorization - dual-eligible participation

(1)
The state department is authorized to ensure the participation of Colorado medical assistance recipients, who are also eligible for medicare, in any federal prescription drug benefit enacted for medicare recipients.
(2)
Prescribed drugs shall not be a covered benefit under the medical assistance program for a recipient who is eligible for a prescription drug benefit program under medicare; except that, if a prescribed drug is not a covered Part D drug as defined in the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003", Pub.L. 108-173, the prescribed drug may be a covered benefit if it is otherwise covered under the medical assistance program and federal financial participation is available.
L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1. L. 2007: (2) amended, p. 1631, § 1, effective July 1.
This section is similar to former § 26-4-406.5 as it existed prior to 2006.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For additional information on the federal "Medicare Prescription Drug, Improvement, and Modernization Act of 2003", see Pub.L. 108-173 .
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-503 - [Effective 8/7/2024] Prescription drug benefits - authorization - dual-eligible participation

(1)
The state department is authorized to ensure the participation of Colorado medical assistance members, who are also eligible for medicare, in any federal prescription drug benefit enacted for medicare recipients.
(2)
Prescribed drugs are not a covered benefit under the medical assistance program for a Member who is eligible for a prescription drug benefit program under medicare; except that, if a prescribed drug is not a covered Part D drug as defined in the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003", Pub.L. 108-173, the prescribed drug may be a covered benefit if it is otherwise covered under the medical assistance program and federal financial participation is available.
Amended by 2024 Ch. 152,§ 64, eff. 8/7/2024.
L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1. L. 2007: (2) amended, p. 1631, § 1, effective July 1.
This section is similar to former § 26-4-406.5 as it existed prior to 2006.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
For additional information on the federal "Medicare Prescription Drug, Improvement, and Modernization Act of 2003", see Pub.L. 108-173 .
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-504 - [Effective Until 8/7/2024] Providers of pharmaceutical services

(1)
Consistent with the provisions of section
25.5-4-401 (1)
, and consistent with subsections (2) and (3) of this section, and subject to available appropriations, no provider of pharmaceutical services who meets the conditions imposed by this article and articles
4
and
6
of this title and who complies with the terms and conditions established by the state department and contracting health maintenance organizations and prepaid health plans shall be excluded from contracting for the provision of pharmaceutical services to recipients authorized in this article and articles
4
and
6
of this title.
(2)
This provision shall not apply to a health maintenance organization or prepaid health plan that enrolls less than forty percent of all the resident medicaid recipients in any county with over one thousand medicaid recipients.
(3)
The state board shall establish specifications in rules in order to provide criteria to health maintenance organizations and prepaid health plans which ensure the accessibility and quality of service to clients and the terms and conditions for pharmaceutical contracts.
L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1.
This section is similar to former § 26-4-407 as it existed prior to 2006.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-504 - [Effective 8/7/2024] Providers of pharmaceutical services

(1)
Consistent with the provisions of section
25.5-4-401 (1)
and subsections (2) and (3) of this section, and subject to available appropriations, no provider of pharmaceutical services who meets the conditions imposed by this article 5 and articles 4 and 6 of this title 25.5 and who complies with the terms and conditions established by the state department and contracting health maintenance organizations and prepaid health plans shall be excluded from contracting for the provision of pharmaceutical services to members authorized in this article 5 and articles 4 and 6 of this title 25.5.
(2)
This provision does not apply to a health maintenance organization or prepaid health plan that enrolls less than forty percent of all the resident medicaid members in any county with over one thousand medicaid members.
(3)
The state board shall establish specifications in rules in order to provide criteria to health maintenance organizations and prepaid health plans which ensure the accessibility and quality of service to members and the terms and conditions for pharmaceutical contracts.
Amended by 2024 Ch. 152,§ 65, eff. 8/7/2024.
L. 2006: Entire article added with relocations, p. 1905, § 7, effective July 1.
This section is similar to former § 26-4-407 as it existed prior to 2006.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-506 - Prescribed drugs - utilization review

(1)
The state department shall develop and implement a drug utilization review process to assure the appropriate utilization of drugs by patients receiving medical assistance in the fee-for-service and primary care physician programs. The review process shall include the monitoring of prescription information and shall address at a minimum underutilization and overutilization of benefit drugs. Periodic reports of findings and recommendations shall be forwarded to the state department.
(2)
It is the general assembly's intent that the implementation of a drug utilization review process for the fee-for-service and primary care physician programs will produce savings within the state's medicaid program. The state department, therefore, is authorized to use savings in the medical services premiums appropriations to fund the development and implementation of a drug utilization review process for these programs, as required by subsection (1) of this section. The state department may contract on a contingency basis for the development or implementation of the review process required by subsection (1) of this section.
(3)
(a)
The state department shall implement drug utilization mechanisms, including, but not limited to, prior authorization, to control costs in the medical assistance program associated with prescribed drugs. The state board shall promulgate a rule that outlines a process in which any interested party may be notified of and comment on the implementation of any prior authorization for a class of prescribed drugs before the class is prior authorized.
(b)
Repealed.
Amended by 2016 Ch. 22,§ 4, eff. 8/10/2016.
L. 2006: Entire article added with relocations, p. 1906, § 7, effective July 1. L. 2016: (3)(b) repealed, (HB 16-1081), ch. 22, p. 51, § 4, effective August 10.
This section is similar to former § 26-4-408 as it existed prior to 2006.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-507 - Prescription drug information and technical assistance program - rules

There is hereby created the prescription drug information and technical assistance program. The program shall provide advice on the prudent use of prescription drugs to persons who receive prescription drug benefits pursuant to this part 5. The state department shall contract with licensed pharmacists for statewide medicaid pharmacy services and pharmacy consultations for persons receiving prescription drug benefits pursuant to this part 5 regarding how each person may, with the approval of the appropriate prescribing health-care provider, avoid dangerous drug interactions, improve patient outcomes, and save the state money for the drugs prescribed. The state department shall promulgate rules to establish and administer the program and to provide incentive payments to pharmacists and physicians who participate in the program. The state department shall design a calculation for savings under the program.
L. 2007: Entire section added, p. 1631, § 2, effective July 1.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-508 - [Repealed]

L. 2009: Entire section added, (HB 09-1073), ch. 282, p. 1286, §1, effective August 5.
Subsection (4) provided for the repeal of this section, effective July 1, 2010. (See L. 2009, p. 1286.)
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-509 - [Effective Until 8/7/2024] Substance use disorder - prescription drugs - opioid antagonist - definition

(1)
Notwithstanding any provisions of this part 5 to the contrary, for the treatment of a substance use disorder, in promulgating rules, and subject to any necessary federal authorization, the state board shall authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization.
(2)
(a)
As used in this subsection (2), unless the context otherwise requires, "opioid antagonist" has the same meaning as set forth in section
12-30-110 (7)(d)
.
(b)
A hospital or emergency department shall receive reimbursement under the medical assistance program for the cost of an opioid antagonist if, in accordance with section
12-30-110
, a prescriber, as defined in section
12-30-110 (7)(h)
, dispenses an opioid antagonist upon discharge to a medical assistance recipient who is at risk of experiencing an opioid-related drug overdose event or to a family member, friend, or other person in a position to assist a medical assistance recipient who is at risk of experiencing an opioid-related drug overdose event.
(c)
The state department shall seek federal financial participation for the cost of reimbursement for the opioid antagonist, but shall provide reimbursement to the hospital or emergency department for the opioid antagonist using state money until federal financial participation is available.
Amended by 2024 Ch. 458,§ 23, eff. 6/6/2024.
Amended by 2022 Ch. 225, § 50, eff. 7/1/2022.
Added by 2018 Ch. 225, § 6, eff. 1/1/2019.
L. 2018: Entire section added (HB 18-1007), ch. 225, p. 1433, § 6, effective 1/1/2019.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-509 - [Effective 8/7/2024] Substance use disorder - prescription drugs - opiate antagonist

(1)
Notwithstanding any provisions of this part 5 to the contrary, for the treatment of a substance use disorder, in promulgating rules, and subject to any necessary federal authorization, the state board shall authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization.
(2)
(a)
As used in this subsection (2), unless the context otherwise requires, "opioid antagonist" has the same meaning as set forth in section
12-30-110 (7)(d)
.
(b)
A hospital or emergency department shall receive reimbursement under the medical assistance program for the cost of an opioid antagonist if, in accordance with section
12-30-110
, a prescriber, as defined in section
12-30-110 (7)(h)
, dispenses an opioid antagonist upon discharge to a medical assistance Member who is at risk of experiencing an opioid-related drug overdose event or to a family member, friend, or other person in a position to assist a medical assistance Member who is at risk of experiencing an opioid-related drug overdose event.
(c)
The state department shall seek federal financial participation for the cost of reimbursement for the opioid antagonist, but shall provide reimbursement to the hospital or emergency department for the opioid antagonist using state money until federal financial participation is available.
Amended by 2024 Ch. 152,§ 67, eff. 8/7/2024.
Amended by 2024 Ch. 458,§ 23, eff. 6/6/2024.
Amended by 2022 Ch. 225, § 50, eff. 7/1/2022.
Added by 2018 Ch. 225, § 6, eff. 1/1/2019.
L. 2018: Entire section added (HB 18-1007), ch. 225, p. 1433, § 6, effective 1/1/2019.
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-510 - [Effective Until 8/7/2024] Pharmacy reimbursement - substance use disorder - injections

If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section
12-280-602
to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the drug shall receive an enhanced dispensing fee that aligns with the administration fee paid to a provider in a clinical setting.
Amended by 2019 Ch. 136, § 188, eff. 10/1/2019.
Added by 2018 Ch. 225, § 7, eff. 1/1/2019.
L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1433, § 7, effective 1/1/2019.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-510 - [Effective 8/7/2024] Pharmacy reimbursement - substance use disorder - injections

A pharmacy administering injectable antagonist medication for medication-assisted treatment for substance use disorders shall receive an enhanced dispensing fee that aligns with the administration fee paid to a provider in a clinical setting.
Amended by 2024 Ch. 470,§ 24, eff. 8/7/2024.
Amended by 2019 Ch. 136, § 188, eff. 10/1/2019.
Added by 2018 Ch. 225, § 7, eff. 1/1/2019.
L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1433, § 7, effective 1/1/2019.
2024 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-512 - Pharmacy benefit - mental health and substance use disorders - legislative declaration

(1)
(a)
The general assembly finds and declares that:
(I)
It is estimated that over one million Coloradans experience a mental health or substance use disorder each year, yet less than half of the adult population in this state receives the care it needs;
(II)
It is well documented that access to appropriate treatments, including medication, can lead to better outcomes for individuals dealing with these diagnoses;
(III)
For this reason, policies that restrict access to medications lead to poorer outcomes and increased health-care costs;
(IV)
Pharmacists also play an important role in improving access to treatments for serious mental illness and substance use disorders; and
(V)
The use of extended-release injectable medications for serious mental illness and substance use disorders has research-proven clinical benefits compared to oral medications, including medication adherence and significant delay and reduction in relapse, which decreases criminal recidivism and emergency room visits for patients from vulnerable populations, particularly those experiencing homelessness.
(b)
Therefore, the general assembly declares that access to these treatments through a pharmacy benefit under the medical assistance program will improve access to mental health providers by allowing pharmacists to dispense, administer, and be reimbursed for these important and effective medications.
(2)
A pharmacist or pharmacy that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders may seek reimbursement for those medications under the medical assistance program either as a pharmacy benefit or as a medical benefit.
Added by 2021 Ch. 470,§1, eff. 9/7/2021.
L. 2021: Entire section added, (HB 21-1275), ch. 3377, p. 3377, § 1, effective September 7.
2021 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-512.5 - [Effective 8/7/2024] Medications for opioid use disorder - pharmacists - reimbursement - definition

(1)
As used in this section, unless the context otherwise requires, "medications for opioid use disorder" or "MOUD" has the meaning as set forth in section 12-280-103 (27.5).
(2)
The state department shall reimburse a licensed pharmacist for prescribing or administering medications for an opioid use disorder, if the pharmacist is authorized pursuant to article 280 of title 12, at a rate equal to the reimbursement provided to a physician, physician assistant, or advanced practice registered nurse for the same services.
(3)
The state department shall seek any federal authorization necessary to implement this section.
Added by 2024 Ch. 470,§ 25, eff. 8/7/2024.
2024 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-513 - Pharmacy benefits - prescription drugs - rebates - analysis

(1)
Beginning in 2023, the state department shall, in collaboration with the administrator of the all-payer health claims database described in section
25.5-1-204
, conduct an annual analysis of the prescription drug rebates received in the previous calendar year, by health insurance carrier and prescription drug tier. The analysis, using data from the all-payer health claims database and other sources, must be completed on or before May 1 of each year.
(2)
The state department shall make the analysis conducted in subsection (1) of this section available to the public on an annual basis.
Added by 2022 Ch. 184, § 7, eff. 8/10/2022.
2022 Ch. 184, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-514 - [Effective Until 8/7/2024] Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition

(1)
As used in this section, "HIV" means human immunodeficiency virus.
(2)
(a)
Before July 1, 2027, the state department shall not restrict by prior authorization or step therapy requirements any prescription drug approved by the federal food and drug administration that is used for the treatment or prevention of HIV if a prescribing practitioner licensed pursuant to title 12 has determined the prescription drug to be medically necessary for the treatment or prevention of HIV for a recipient. Prescription drugs used for the treatment or prevention of HIV include protease inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, antivirals, integrase inhibitors, long-acting medications, and fusion inhibitors.
(b)
Nothing in this subsection (2) prevents the state department from performing drug utilization review that may be necessary for patient safety or for ensuring the prescribed use is for a medically accepted indication, as required by section 1927 of the "Social Security Act of 1935".
Added by 2023 Ch. 69,§ 9, eff. 4/14/2023.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-514 - [Effective 8/7/2024] Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition

(1)
As used in this section, "HIV" means human immunodeficiency virus.
(2)
(a)
Before July 1, 2027, the state department shall not restrict by prior authorization or step therapy requirements any prescription drug approved by the federal food and drug administration that is used for the treatment or prevention of HIV if a prescribing practitioner licensed pursuant to title 12 has determined the prescription drug to be medically necessary for the treatment or prevention of HIV for a Member. Prescription drugs used for the treatment or prevention of HIV include protease inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, antivirals, integrase inhibitors, long-acting medications, and fusion inhibitors.
(b)
Nothing in this subsection (2) prevents the state department from performing drug utilization review that may be necessary for patient safety or for ensuring the prescribed use is for a medically accepted indication, as required by section 1927 of the federal "Social Security Act of 1935".
Amended by 2024 Ch. 490,§ 65, eff. 8/7/2024.
Amended by 2024 Ch. 152,§ 68, eff. 8/7/2024.
Added by 2023 Ch. 69,§ 9, eff. 4/14/2023.
2024 Ch. 490, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2024 Ch. 152, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-515 - Pharmacy reimbursement - vaccine administration to children - legislative declaration

(1)
(a)
The general assembly finds and declares that:
(I)
Pharmacists are highly trained and educated, doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;
(II)
Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;
(III)
With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments; and
(IV)
Convenient access to vaccines through a neighborhood pharmacy can help ensure that more children receive their childhood vaccinations according to federal recommended guidelines.
(b)
Therefore, the general assembly declares that allowing reimbursement under the medical assistance program to a pharmacist or pharmacy that dispenses or administers childhood vaccinations is an important tool in ensuring the health of Colorado children through immunization.
(2)
Pursuant to the requirements set forth in subsection (3) of this section, a pharmacist or pharmacy that dispenses or administers vaccinations to children under nineteen years of age pursuant to the federal centers for disease control and prevention's guidelines pertaining to the childhood immunization schedule may seek reimbursement for the dispensing or administration of vaccines under the medical assistance program either as a pharmacy benefit or as a medical benefit, as applicable.
(3)
(a)
To be eligible to receive reimbursement pursuant to subsection (2) of this section for administering vaccines to children, a pharmacy or pharmacist must be enrolled in good standing with the vaccines for children program administered by the department of public health and environment.
(b)
Until the department of public health and environment determines a framework for participation by pharmacies and pharmacists in the vaccines for children program, nothing in this section requires the department of public health and environment to enroll pharmacies receiving reimbursement for the administration of vaccines through the medical assistance program as vaccines for children providers.
(c)
As used in this subsection (3), "vaccines for children program" means the federal centers for disease control and prevention "vaccines for children program" administered by the department of public health and environment, or any successor program.
Added by 2023 Ch. 148,§ 4, eff. 8/7/2023.
2023 Ch. 148, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-516 - Serious mental illness - prescribed drugs

Notwithstanding any provisions of this part 5 to the contrary, and subject to any necessary federal authorization, the state board shall require a review for coverage of a new drug approved by the federal food and drug administration for a serious mental illness within ninety days after the approval of the drug.
Added by 2023 Ch. 394,§ 3, eff. 8/7/2023.
2023 Ch. 394, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 5 - PRESCRIPTION DRUGS (§§ 25.5-5-500.3 — 25.5-5-518) › Section 25.5-5-518 - Coverage for choline dietary supplements

(1)
No later than July 1, 2025, the state board shall promulgate rules to include coverage under the medical assistance program for over-the-counter choline dietary supplements for pregnant persons.
(2)
The state department shall seek federal approval, as necessary, for the coverage described in subsection (1) of this section.
Added by 2024 Ch. 433,§ 5, eff. 6/5/2024.
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 6 - [Repealed] (§ 25.5-5-601) › Section 25.5-5-601 - to 25.5-5-605 - [Repealed]

Section 25.5-5-605 provided for the repeal of this part 6, effective 9/1/2016.
Amended by 2013 Ch. 303, § 7, eff. 5/28/2013.
(1) This part 6 was added in 1995.
(2) Section 25.5-5-605 provided for the repeal of this part 6, effective September 1, 2016. (See L. 2011, p. 1458.)
2023 Colorado Revised Statutes › Title 25.5 - HEALTH CARE POLICY AND FINANCING (§§ 25.5-1-101 — 25.5-11-101) › COLORADO MEDICAL ASSISTANCE ACT (§§ 25.5-4-101 — 25.5-6-2001) › Article 5 - COLORADO MEDICAL ASSISTANCE ACT - SERVICES AND PROGRAMS (§§ 25.5-5-101 — 25.5-5-804) › Part 7 - [Repealed] (§ 25.5-5-701) › Section 25.5-5-701 - to 25.5-5-703 - [Repealed]

L. 2010: Entire part repealed, (HB 10-1322), ch. 29, p. 105, §1, effective March 18.
This part 7 was added in 2006 and was not amended prior to its repeal in 2010. For the text of this part 7 prior to 2010, consult the 2009 Colorado Revised Statutes.