The act requires a health benefit plan, beginning January 1, 2022, to provide coverage for nonpharmacological treatment as an alternative to opioids. The required coverage must include, at a cost-sharing amount not to exceed the cost-sharing amount for a primary care visit for nonpreventive services and without a prior authorization requirement, at least 6 physical therapy visits, 6 occupational therapy visits,6 chiropractic visits, and 6 acupuncture visits per year.
The act requires an insurance carrier (carrier) that provides prescription drug benefits to provide coverage, beginning January 1, 2022, for at least one atypical opioid that is approved by the federal food and drug administration (FDA) for the treatment of acute or chronic pain at the lowest cost-sharing tier of the carrier's formulary with no requirement for step therapy or prior authorization and to not require step therapy for any additional FDA-approved atypical opioids.
The act precludes a carrier that has a contract with a physical therapist, occupational therapist, or acupuncturist from:
- Prohibiting the physical therapist, occupational therapist, or acupuncturist from, or penalizing the physical therapist, occupational therapist, or acupuncturist for, providing a covered person information on the amount of the covered person's financial responsibility for the covered person's physical therapy, occupational therapy, or acupuncture services; or
- Requiring the physical therapist, occupational therapist, or acupuncturist to charge or collect a copayment from a covered person that exceeds the total charges submitted by the physical therapist, occupational therapist, or acupuncturist.
The commissioner of insurance is required to take action against a carrier that the commissioner determines is not complying with these prohibitions.
The act requires the executive director of the department of regulatory agencies to promulgate rules that limit the supply of a benzodiazepine that a prescriber may prescribe to patient who has not had a prescription for benzodiazepine in the last 12 months.
Current law limits an opioid prescriber from prescribing more than a 7-day supply of an opioid to a patient who has not had an opioid prescription within the previous 12 months unless certain conditions apply, and this prescribing limitation is set to repeal on September 1, 2021. The act continues the prescribing limitation indefinitely.
The act requires the Colorado medical board (board) to consult with the center for research into substance use disorder prevention, treatment, and recovery support strategies to promulgate rules establishing competency-based continuing education requirements for physicians and physician assistants concerning prescribing practices for opioids.
With regard to the prescription drug monitoring program (program), the act:
- Modifies requirements for adding prescription information to the program; (program)
- Prohibits the state board of pharmacy from charging practitioners or pharmacists a fee for registering or maintaining an account with the program;
- Continues indefinitely the requirement that a health care provider query the program before prescribing a second fill for an opioid;
- Requires each health care provider to query the program before prescribing a second fill for a benzodiazepine, unless certain exceptions apply;
- Requires the board to promulgate rules designating additional controlled substances and other prescription drugs to be tracked by the program; and
- In addition to current law allowing medical examiners and coroners to query the program when conducting an autopsy, allows medical examiners and coroners to query the program when conducting a death investigation.
The act appropriates $18,540 from the division of professions and occupations cash fund to the department of regulatory agencies to implement the act, with $2,550 allocated to the Colorado medical board and $15,990 reappropriated to the department of law to provide legal services to the department of regulatory agencies.
(Note: This summary applies to this bill as enacted.)