Bill Summary for Bill Number SB13-277

Date: 05/02/2013

Final
BILL SUMMARY for SB13-277

HOUSE COMMITTEE ON HEALTH, INSURANCE & ENVIRONMENT

Votes: View-->	Action Taken:
Refer Senate Bill 13-277 to the Committee on Appro	PASS

01:34 PM -- Senate Bill 13-277

Representative Ginal presented Senate Bill 13-277 concerning the development of a prior authorization process to be used in obtaining prior approval from carriers for coverage of drug benefits. The bill requires the Commissioner of Insurance in the Department of Regulatory Agencies to develop by July 31, 2014, by rule, a uniform prior authorization process for insurance carriers to submit and receive requests for prior coverage approval of a drug benefit. Prior authorization is an extra step that some insurance carriers require before deciding to approve coverage of a patient's medicine. Under the prior authorization process to be developed by the commissioner, insurance carriers and pharmacy benefit management firms will be required to:

make the process available electronically, but must not require the prescribing provider to submit a prior authorization request electronically;
make certain items accessible in a centralized location on the their web sites;
use evidence-based guidelines, when possible, when making prior authorization determinations;
include certain information in its prior approval notification; and
inform a prescribing provider that the covered person has a right to appeal the denial of a prior approval request.

The bill requires the commissioner to appoint a working group within 30 days of the bill's effective date for purposed of assisting in the development of the prior authorization process. The work group's recommendations must be made not later than six months after the date on which membership appointments are made. As part of the rule promulgation, the commissioner is required to develop a standardized prior authorization form that is not to exceed two pages in length. The commissioner is required to take into consideration existing forms, including those established by the federal Centers for Medicare and Medicaid Services and the Department of Health Care Policy and Financing.

Carriers are required to begin using the prior authorization process on January 1, 2015. A request for prior authorization is deemed granted if a carrier fails to use the prior authorization process or fails to respond within two business days to any request submitted electronically, subject to certain conditions. The deadline for nonurgent requests is three business days. Urgent requests must be responded to within one business day. Once approved, a prior authorization is valid for at least 180 from the date of approval.

Representative Ginal provided several handouts to the committee (Attachments A through E).

130502 AttachE.pdf

01:39 PM -- Dr. Jan Kief, Colorado Medical Society, testified in support of the bill. She discussed the issues with the current prior authorization process. Dr. Kief responded to questions about why standardization of the prior authorization process has not happened before.

01:43 PM -- Dr. Alvin Otsuka, Rocky Mountain Cancer Center, testified in support of the bill. He discussed the costs of the current prior authorization process, the current practice of following nationally published guidelines for cancer treatments, and how the standardization of the prior authorization process will help reduce medical care costs.

01:46 PM -- Marcus Garcia, Rocky Mountain Cancer Center, testified in support of the bill. He discussed the prior authorization process and delays in care due to waiting for insurance authorizations. Mr. Garcia responded to questions about the prior authorization forms.

01:50 PM

Representative Joshi discussed his experience with the prior authorization process.


BILL:	SB13-277
TIME:	01:50:08 PM
MOVED:	Ginal
MOTION:	Refer Senate Bill 13-277 to the Committee on Appropriations. The motion passed on a vote of 11-0.
SECONDED:	Schafer
		VOTE
	Conti	Yes
	Fields	Yes
	Ginal	Yes
	Humphrey	Yes
	Joshi	Yes
	Primavera	Yes
	Stephens	Yes
	Swalm	Yes
	Young	Yes
	Schafer	Yes
	McCann	Yes

Final YES: 11 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: PASS