Drug Coverage For Serious Mental Illness

Effective January 1, 2025, with respect to step-therapy protocols (protocols) for health insurance, section 1 of the act defines "serious mental illness" and prohibits the protocols from requiring a person to try more than one prescription drug prior to receiving coverage for the drug prescribed by the person's health-care provider. If certain conditions are met and attested to by the person's health-care provider, the carrier, private utilization review organization, or pharmacy benefit manager must cover the drug prescribed by the person's health-care provider without requiring compliance with protocols. Section 2 of the act defines "serious mental illness" for purposes of the "Colorado Medical Assistance Act" in the same manner as the term is defined for commercial health insurance. The act requires the medical services board to require a review for coverage of a new drug approved by the federal food and drug administration for a serious mental illness within 90 days after the drug is approved. The act appropriates $53,117 to the department of health care policy and financing (department) from the general fund for use by the executive director's office to implement the act, with the assumption that the department will receive an equal amount of federal funds to implement the act. APPROVED by Governor June 6, 2023 PORTIONS EFFECTIVE August 7, 2023 PORTIONS EFFECTIVE January 1, 2025 NOTE: This act was passed without a safety clause. (Note: This summary applies to this bill as enacted.)