Second Regular Session
              Sixty-eighth General Assembly
                    STATE OF COLORADO
                                                 INTRODUCED
                                                           
                                                           
 LLS NO. 12-0318.01 Christy Chase x2008  SENATE BILL 12-065
                   SENATE SPONSORSHIP
 Morse, 
 
                    HOUSE SPONSORSHIP
 (None),
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Senate Committees
 House Committees
 
 
 Health and Human Services
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                         A BILL FOR AN ACT
       Concerning the development of a prior authorization form
            to be used by health benefit plans that cover
            prescription drug benefits.
       
       
                           Bill Summary
       
            (Note: This summary applies to this bill as introduced and does
       not reflect any amendments that may be subsequently adopted. If this bill
       passes third reading in the house of introduction, a bill summary that
       applies to the reengrossed version of this bill will be available at
       http://www.leg.state.co.us/billsummaries.)
       
            The bill requires the commissioner of insurance to develop by July
       1, 2013, and requires prescribing providers and health benefit plans to use
       by January 1, 2014, a uniform prior authorization form for purposes of
       submitting and receiving requests for prior coverage approval of a
       prescription drug. If the health benefit plan fails to use or accept the prior
       authorization form or fails to respond to a request within 2 business days,
       the request is deemed granted. An approved prior authorization form is
       valid for 12 months after the date of approval.
       
       
       
       Be it enacted by the General Assembly of the State of Colorado:
            SECTION 1.  In Colorado Revised Statutes, add 10-16-124.5 as
       follows:
            10-16-124.5.  Prior authorization form - prescription drugs -
       commissioner rules. (1)  Notwithstanding any other provision of
       law, on and after January 1, 2014, a health benefit plan that
       provides coverage for prescription drugs shall utilize and
       accept only the prior authorization form developed pursuant to
       subsection (3) of this section when requiring prior authorization
       for prescription drug benefits.
            (2)  If a health benefit plan fails to utilize or accept the
       prior authorization form, or fails to respond within two business
       days upon receipt of a prior authorization request from a
       prescribing provider, the prior authorization request is deemed
       granted.
            (3)  On or before July 1, 2013, the commissioner shall
       develop by rule a uniform prior authorization form that:
            (a)  Does not exceed two pages in length;
            (b)  Is made available electronically by the division and
       the carrier;
            (c)  Can be completed and submitted electronically by the
       prescribing provider to the carrier; and
            (d)  Is developed with input from interested parties at not
       less than one public meeting.
            (4)  Notwithstanding any other provision of law, on and
       after January 1, 2014, every prescribing provider shall use the
       prior authorization form developed pursuant to subsection (3)
       of this section to request prior authorization for coverage of
       prescription drugs, and every health benefit plan shall accept
       that form as sufficient to request prior authorization for
       prescription drug benefits.
            (5)  Upon approval by the health benefit plan, a prior
       authorization is valid for twelve months after that date of
       approval.
            (6)  As used in this section, a "prescribing provider" means
       a provider who is authorized by law to prescribe any drug or
       device to treat a medical condition of an insured and who is
       acting within the scope of that authority.
            SECTION 2.  Act subject to petition - effective date. This act
       takes effect at 12:01 a.m. on the day following the expiration of the
       ninety-day period after final adjournment of the general assembly (August
       7, 2012, if adjournment sine die is on May 9, 2012); except that, if a
       referendum petition is filed pursuant to section 1 (3) of article V of the
       state constitution against this act or an item, section, or part of this act
       within such period, then the act, item, section, or part will not take effect
       unless approved by the people at the general election to be held in
       November 2012 and, in such case, will take effect on the date of the
       official declaration of the vote thereon by the governor.