CO| The Amended Regulation (4-2-49), concerning the development and implementation of a uniform drug benefit prior authorization process and required drug appeals process, establishes requirements for carriers offering health benefit plans in Colorado that provide prescription drug benefits. It outlines the process for prior authorization requests, including standard and expedited exception processes, notification requirements, and timelines for urgent and non-urgent requests. The regulation also specifies the duration of prior authorization approvals and includes additional requirements for specific prescription drugs, such as those used for medication-assisted treatment of substance use disorders and chronic maintenance drugs. Amended regulation effective March, 30, 2025.
Key points:
- Beginning January 1, 2026, prior authorization approvals for requests not subject to certain exceptions will be valid for at least one year from the date of approval.
- Starting January 1, 2027, carriers must accept and respond to provider prior authorization requests through secure electronic transmission systems.