On Jun. 6, COL INS proposed regulation on prescription drug coverage
COL INS proposed new Regulation 4-2-XX concerning requirements for insurers using step therapy utilization for prescription drug coverage for serious mental illness.
Regulation to implement bill HB23-1130 and to establish requirements, see #175396.
Proposed Regulation
Establishes requirements, process, and form to be utilized by health benefit plans for step therapy utilization and exceptions for enrollees with serious mental illnesses.
If health benefit requires step therapy for prescription medication to treat a serious mental illness, it may only require a covered person to try one prescription drug.
Other than the drug prescribed by the provider prior to covering the drug prescribed by the covered person’s provider and the provider’s determination shall be final.
Carrier must cover the prescription drug without additional step therapy requirements.
Insurer to use attestation exception form for providers for use in exceptions to step therapy for an enrollee with a serious mental illness if certain conditions are met.
Shall authorize coverage for a prescription drug prescribed by the covered person’s provider when a step-therapy attestation exception form is submitted for that drug.
Consultation
Comments on proposed regulation are due by 5:00pm on Jun. 12, 2024.
Jul. 16, 2024 COL INS Hearing Notice
On Jul. 16, 2024, COL INS reported a rule hearing is scheduled for Aug. 19, 2024.
