SB 23-189

Abstract

Sections 1, 2, 3, and 5 of the bill change the defined term "HIV infection prevention drug", as it appears and is used in several areas of law, to "HIV prevention drug".Section 2 also: Adds the advisory committee on immunization practices to the centers for disease control and prevention in the federal department of health and human services (HHS) recommendations and the women's and infants', children's, and adolescents' and preventive services guidelines of the health resources and services administration in the United States department of health and human services HHS to the mandatory preventive health-care services coverage for health benefit plans; Specifies that, the mandatory preventive health-care services benefit for counseling for, prevention of, and screening for the sexually transmitted infection includes 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 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, as described in the bill, based on the most recent guidelines and clinical guidance consistent with federal guidelines ; Requires large employer plans, 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 plans must provide this coverage if the federal department of health and human services confirms the state's determination that the coverage is not subject to state defrayal pursuant to federal law. To the extent required by binding federal jurisprudence, 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 . Specifies that 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. Section 3 also 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 bill also 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 HIV treatment drugs and to provide the study to the general assembly by October 1, 2026.Section 4 prohibits a carrier from imposing on coverage for:The treatment of a sexually transmitted infection; orSterilization services, which coverage must be provided regardless of the covered person's gender; requires that, if the treatment of STIs and sterilization services are covered services, a health benefit plan must provide coverage 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. With the minor's consent, section 6 allows a health-care provider acting within the scope of the health-care provider's license, certificate, or registration to furnish contraceptive procedures, supplies, or information to the 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.Sections 7 and 8 expand the reproductive health-care program administered by the department of health care policy and financing ( state department) to include additional family planning services and family-planning-related services. and allow individuals under 19 years of age to apply for and enroll themselves in the program.Section 9 requires the department to reimburse licensed health-care providers for family planning services and family-planning-related services provided to a minor and creates a cash fund from which the general assembly may appropriate money to the department for this purpose. Section 10 exempts the cash fund from the limit on uncommitted cash fund reserves.Section 11 requires nonemergency medical transportation services under the state medical assistance program to include expenses for transportation to medical services that are prohibited from coverage pursuant to section 50 of article V of the Colorado constitution.Section 12 9 of the bill prohibits the use before July 1, 2027, the state department, under the state medical assistance program, of utilization management, including from using prior authorization and or step therapy requirements for prescription drugs prescribed for the treatment or prevention of HIV, except for utilization review that is necessary for safety or for ensuring the prescribed use is for a medically accepted indication .Section 10 of the bill replaces outdated language in the legislative declaration for family planning services under the department of public health and environment (department). Section 11 of the bill requires the 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. The bill appropriates $200,000 to the department for the family planning access collaborative and report.Section 12 of the bill specifies the prior authorization requirements and time frames for health insurance carriers for prior authorization of HIV prescription drugs not on the insurance carrier's formulary as of March 1, 2023, to require approval or denial within one day after receipt of a request. Section 13 of the bill makes appropriations. (Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.) (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)