Representative Herod, bill co-sponsor, introduced HB21-1276.  The bill makes several changes to state law concerning the prevention of opioid and other substance use disorders, as described below.

Health insurance provisions.  The bill places several restrictions and requirements on insurance carriers and health benefit plans relating to opioids and alternative treatments for certain plans issued or renewed beginning January 1, 2023.

• Physical therapists, occupational therapists, chiropractors, or acupuncturists.  The bill prevents an insurance carrier that has a contract with a physical therapist, occupational therapist, chiropractor, or acupuncturist from prohibiting or penalizing these practitioners for providing a covered person with information on their financial responsibility for such services.  When the covered person starts treatment, the provider must notify the person's insurance carrier.  In addition, an insurance carrier cannot require such a practitioner to charge or collect a co-payment that exceeds the total charges submitted.  If the Commissioner of Insurance in the Department of Regulatory Agencies (DORA) determines that an insurance carrier has engaged in these practices, then the commissioner is required to institute a corrective action plan for the insurance carrier to follow.

Atypical opioid or non-opioid medication.  The bill requires insurance carriers to provide coverage for an atypical opioid or non-opioid medication that is approved by the federal Food and Drug Administration (FDA) and prohibits carriers from mandating a covered person undergo step therapy or requiring pre-authorization.  The insurance carrier is required to make the atypical opioid or non-opioid medication available at the lowest cost-sharing tier under the health benefit plan applicable to a covered opioid with the same indication.

Mandatory coverage provisions.  The bill requires each health benefit plan to provide coverage for a minimum number of physical therapy visits, occupational therapy visits, chiropractic visits, and acupuncture visits, at a cost-sharing amount not to exceed the cost-sharing amount for a primary care visit for non-preventive services.

Prescribing limitations.  Under current law, an opioid prescriber is prevented from prescribing more than a seven-day supply of an opioid to a patient that has not had an opioid prescription in the last 12 months unless certain conditions apply.  The executive director of DORA is required to, by rule, limit the supply of a benzodiazepine that a prescriber may prescribe to a patient who has not been prescribed benzodiazepine in the last 12 months by that prescriber.  Benzodiazepines may be prescribed electronically.  The current opioid prescribing limit is set to repeal on September 1, 2021. The bill continues the prescribing limitation indefinitely.

Prescription drug monitoring program (PDMP).  Under current law, health care providers are required to query the PDMP before prescribing a second fill for an opioid.  This requirement, which is set to repeal on September 1, 2021, is continued indefinitely by the bill.  In addition, the bill requires health care providers to query the PDMP before prescribing or refilling a benzodiazepine.  Lastly, the bill allows health information organization networks to access to the program if the State Medical Board can accomplish this with existing program funds.

Education for providers.  The bill authorizes the Center for Research into Substance Use Disorder Prevention, Treatment, and Recovery Support Strategies (center) at the Colorado Health Sciences Center to include in its educational activities the best practices for prescribing benzodiazepines and the potential harm of inappropriately limiting prescriptions to chronic pain patients.  The bill adds an emphasis for these educational activities to be directed to physicians, physician assistants, nurses, and dentists serving underserved populations and communities.  In addition, the bill directs the executive director of DORA to consult with the center and the State Medical Board to promulgate rules establishing competency-based continuing education requirements for physicians and physician’s assistants concerning prescribing practices for opioids.

Colorado Substance Use Disorders Prevention Collaborative.  The bill directs the Office of Behavioral Health in the Department of Human Services to convene a collaborative with institutions of higher education, nonprofit agencies, and state agencies to gather feedback on evidence-based prevention practices and other functions related to preventative health, to be funded from the Marijuana Tax Cash Fund.  The office is required to report its progress to the General Assembly each September from 2022 to 2025, when the collaborative repeals.

The bill sponsors responded to questions from the committee.

Dr. Robert Valuck, Colorado Consortium for Prescription Drug Abuse Prevention, testified in support of the bill. Ms. Lauren Snyder, Mental Health Colorado, testified in support of the bill. Dr. Jonathan Clapp, Colorado Medical Society and Colorado Pain Society, testified to amend the bill. The witnesses responded to questions from the committee.

Mr. Butch Lewis, Colorado Providers Association, testified in support of the bill.  Ms. Jeanette Hensley, Colorado Senior Lobby, testified to amend the bill.  Dr. Alexis Ritvo, representing herself, testified in support of the bill.  Ms. Terri Schreiber, Benzo Action Work Group of the Colorado Consortium, The Schreiber Research Group and person with lived experience of the challenges of long-term benzo prescribing, testified in support of the bill.  Mr. D Foster, representing himself, testified in support of the bill.

Cameron McDonald, American Physical Therapy Association - Colorado Chapter, testified in support of the bill. Tim Flynn, American Physical Therapy Association - Colorado Chapter, testified in support of the bill. Fran Maes, representing herself, testified to amend the bill.

Dr. Michael Neil, Colorado Cross-Disability Coalition, testified to amend the bill.  JoyAnn Ruscha, representing herself, testified to amend the bill.  Mr. Kenneth Maestas, Colorado Cross-Disability Coalition, testified to amend the bill.  Ms. Valerie Schlecht, Colorado Cross-Disability Coalition, testified to amend the bill.  Ms. Sarah Klein, Epilepsy Foundation of Colorado, testified to amend the bill.

The bill sponsors provided closing comments on the bill.

Committee members made closing comments on the bill.