SB 23-189

Abstract

The act changes the term "HIV infection prevention drug", as used in the Colorado Revised Statutes, to "HIV prevention drug". The act specifies that, for health benefit plans issued or renewed on or after January 1, 2025, if counseling, prevention, and screening for a sexually transmitted infection (STI) are covered services, the health benefit plan must provide coverage without cost sharing, regardless of the covered person's gender, and the coverage must include HIV prevention drugs and the services necessary for initiation and continued use of an HIV prevention drug consistent with federal guidelines. The act prohibits, before July 1, 2027, a health insurance carrier from requiring a covered person to undergo step therapy or to receive prior authorization before a health-care provider may prescribe or dispense a medication for the treatment of HIV that is included on the insurance carrier's prescription drug formulary as of March 1, 2023. The act requires the division of insurance to contract for a study, which includes consultation with the HIV community, to consider the predicted costs and health impacts of removing step therapy and prior authorization before a health-care provider may prescribe or dispense HIV treatment drugs and to provide the study to the general assembly by October 1, 2026. The act specifies the requirements and time frames for health insurance carriers for certain prior authorization requests related to HIV prescription drug coverage. Regarding the state medical assistance program, the act prohibits the department of health care policy and financing (state department), before July 1, 2027, from using prior authorization or step therapy requirements for prescription drugs prescribed for the treatment or prevention of HIV, except for utilization review that is necessary for patient safety or for ensuring the prescribed use is for a medically accepted indication. For health benefit plans issued or renewed on or after January 1, 2025, if sterilization services are a covered service, a health benefit plan must provide the coverage regardless of the covered person's sex or gender and without deductibles, copayments, coinsurance, annual or lifetime maximum benefits, or other cost sharing; except that this provision does not apply to a high deductible health benefit plan until the deductible has been met, unless allowed pursuant to federal law. The act requires mandatory preventive health-care services coverage for health benefit plans to include, in addition to the A and B recommendations of the United States preventive services task force, the recommendations of the advisory committee on immunization practices to the centers for disease control and prevention in the federal department of health and human services (HHS) and the women's, infants', children's, and adolescents' preventive services guidelines of the health resources and services administration in the HHS. The act requires large employer health benefit plans issued or renewed on and after January 1, 2025, to provide coverage for the total cost of abortion care without policy deductibles, copayments, or coinsurance. Individual and small group health benefit plans must provide this coverage if the HHS confirms the state's determination that the coverage is not subject to state defrayal pursuant to federal law. The provisions relating to abortion care do not apply to a high deductible health benefit plan until the deductible has been met, unless allowed pursuant to federal law. Employers are exempted from providing coverage if providing coverage conflicts with the employer's sincerely held religious beliefs or the employer is a public entity prohibited by section 50 of article V of the state constitution from using public funds to pay for induced abortions. With the minor's consent, a health-care provider acting within the scope of the health-care provider's license, certificate, or registration, may furnish contraceptive procedures, supplies, or information to a minor without notification to or the consent of the minor's parent or parents, legal guardian, or any other person having custody of or decision-making responsibility for the minor. The act expands the reproductive health-care program administered by the state department to include additional family planning services and family-planning-related services. The act requires the department of public health and environment (department) to convene a family planning access collaborative, on or before September 1, 2023, to advise the department in identifying access gaps that contribute to Coloradans lacking family planning access. The department shall publish its recommendations on or before December 15, 2023. To implement the act, for the 2023-24 state fiscal year the act appropriates: $200,000 to the department of public health and environment from the general fund for the family planning access collaborative and corresponding report; $67,627 and 0.5 FTE to the department of regulatory agencies from the division of insurance cash fund; and $23,263 and .1 FTE to the department of law from reappropriated funds received from the department of regulatory agencies for legal services. APPROVED by Governor April 14, 2023 EFFECTIVE April 14, 2023(Note: This summary applies to this bill as enacted.)