Colorado - SB203

Step therapy bill

Introduced

February 28, 2017

Description

 

As Introduced:

A carrier shall not require a covered person to undergo step therapy, and shall provide coverage for the drug prescribed by the covered person's health care provider as long as the prescribed drug is on the carrier's prescription drug formulary, when:

   
  1. The covered person is undergoing treatment for a terminal condition; or
  2. The covered person has tried a step-therapy-required prescription drug while under his or her current or previous health insurance or health benefit plan, and the prescription drug was discontinued by the manufacturer due to lack of efficacy or effectiveness, diminished effect, or an adverse event.

A carrier that requires step therapy shall provide an override process. A step therapy override determination shall be expeditiously granted when the treating health care provider can show that the carrier's preferred drug is contraindicated or will likely cause an adverse reaction resulting in mental or physical harm to the covered person. 

04/04/17

As Amended:

A carrier shall not require a covered person to undergo step therapy, and shall provide coverage for the drug prescribed by the covered person's health care provider as long as the prescribed drug is on the carrier's prescription drug formulary, when the patient has tried the step therapy-required prescription drugs while under his or her current or previous health insurance or health benefit plan, and such prescription drugs were discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event. Pharmacy drug samples shall not be considered trial and failure of a preferred prescription drug in lieu of trying the step therapy-required prescription drug.

The health carrier, health benefit plan, or utilization review organization may request relevant documentation from the patient or provider to support the override request.

Our Position

Support

Commentary

SB 203 is scheduled for hearing in the House Health, Insurance & Environment Committee on 4/11. 

The Alliance for Patient Access has recently posted a letter campaign on Prescription Process for advocates to send a letter to their Rep. about this bill.  Their CO step therapy letter and instructions may be found at: http://prescriptionprocess.com/take-action/

Original Sponsor 1

Co-Sponsors 0

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