2017 Colorado Revised Statutes
Title 10 - Insurance
Health Care Coverage
Article 16 - Health Care Coverage
Part 1 - General Provisions
§ 10-16-145. Step therapy - prohibited - definitions

(1) For the purposes of this section, "step therapy" means a protocol that requires a covered person to use a prescription drug or sequence of prescription drugs, other than the drug that the covered person's health care provider recommends for the covered person's treatment, before the carrier provides coverage for the recommended prescription drug.

(2) 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.

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

(4) This section does not preclude a carrier from requiring prior authorization for the coverage of a prescribed drug that was covered by the covered person's former health benefit plan.

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