Source: L. 2009: Entire section added, (HB 09-1073), ch. 282, p. 1286, � 1, effective August 5.
Editor's note: Subsection (4) provided for the repeal of this section, effective July 1, 2010. (See L. 2009, p. 1286.)
25.5-5-509. Substance use disorder - prescription drugs - opioid antagonist - definition. (1) Notwithstanding any provisions of this part 5 to the contrary, for the treatment of a substance use disorder, in promulgating rules, and subject to any necessary federal authorization, the state board shall authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization.
(2) (a) As used in this subsection (2), unless the context otherwise requires, opioid antagonist has the same meaning as set forth in section 12-30-110 (7)(d).
(b) A hospital or emergency department shall receive reimbursement under the medical assistance program for the cost of an opioid antagonist if, in accordance with section 12-30-110, a prescriber, as defined in section 12-30-110 (7)(h), dispenses an opioid antagonist upon discharge to a medical assistance member who is at risk of experiencing an opioid-related drug overdose event or to a family member, friend, or other person in a position to assist a medical assistance member who is at risk of experiencing an opioid-related drug overdose event.
(c) The state department shall seek federal financial participation for the cost of reimbursement for the opioid antagonist but shall provide reimbursement to the hospital or emergency department for the opioid antagonist using state money until federal financial participation is available.
Source: L. 2018: Entire section added (HB 18-1007), ch. 225, p. 1433, � 6, effective January 1, 2019. L. 2022: Entire section amended (HB 22-1326), ch. 225, p. 1670, � 50, effective July 1. L. 2024: (2) amended, (HB 24-1037), ch. 458, p. 3173, � 23, effective June 6; (2)(b) amended, (SB 24-176), ch. 152, p. 658, � 67, effective August 7.
Editor's note: Amendments to subsection (2)(b) by HB 24-1037 and SB 24-176 were harmonized.
Cross references: For the legislative declaration in HB 22-1326 stating the purpose of, and the provision directing legislative staff agencies to conduct, a post-enactment review pursuant to � 2-2-1201 scheduled in 2024, 2025, and 2027, see sections 1 and 55 of chapter 225, Session Laws of Colorado 2022. To obtain a copy of the review, once completed, go to Legislative Resources and Requirements on the Colorado General Assembly's website.
25.5-5-510. Pharmacy reimbursement - substance use disorder - injections. A pharmacy administering injectable antagonist medication for medication-assisted treatment for substance use disorders shall receive an enhanced dispensing fee that aligns with the administration fee paid to a provider in a clinical setting.
Source: L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1433, � 7, effective January 1, 2019. L. 2019: Entire section amended, (HB 19-1172), ch. 136, p. 1710, � 188, effective October 1. L. 2024: Entire section amended, (HB 24-1045), ch. 470, p. 3289, � 24, effective August 7.
25.5-5-511. Reimbursement for pharmacists' services - legislative declaration. (1) (a) The general assembly finds and declares that:
(I) Pharmacists are highly trained and educated doctorate-level health-care professionals specializing in the effective use of medications and their outcomes;
(II) Pharmacists provide health care throughout the entire health-care system, practicing in community pharmacies, hospitals, provider clinic offices, and specialty areas;
(III) With ninety percent of Americans living within five miles of a pharmacy, pharmacists are able to provide valuable public health services to communities and to provide those services in novel ways, including during nontraditional hours and without appointments;
(IV) As part of an integrated team, pharmacists have been proven to lower the overall cost of health care and improve long-term chronic disease outcomes; however, despite these recognized benefits, pharmacists are not considered reimbursable medical providers;
(V) Further, pharmacists in integrated medical homes under the medical assistance program are not supported by the same funding mechanisms as other providers, including rate setting for federally qualified health centers or through fee-for-service billing;
(VI) Without the ability to generate revenue through direct reimbursement or new value-based models, the services pharmacists provide are not sustainable;
(VII) Colorado has recognized that there is a shortage in primary care providers for individuals enrolled in the medical assistance program; and
(VIII) Pharmacists can help address this shortage by providing certain primary care services as a follow-up to physician care through collaborative practice models, including the provision of chronic disease management.
(b) Therefore, the general assembly declares that the ability of pharmacists to generate revenue for the same services provided by other health-care providers would be equitable, would help fund staff and services in medical homes, and would alleviate barriers to access of care in community settings.
(2) (a) A pharmacist is eligible to receive reimbursement under the medical assistance program for medically necessary services authorized in part 6 of article 280 of title 12 that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program.
(b) The state department shall include the services reimbursed pursuant to subsection (2)(a) of this section in the review of provider rates required pursuant to section 25.5-4-401.5.
(3) The state department shall request any federal authorization necessary to receive federal financial participation under the medical assistance program.
Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3377, � 1, effective September 7.
25.5-5-512. Pharmacy benefit - mental health and substance use disorders - legislative declaration. (1) (a) The general assembly finds and declares that:
(I) It is estimated that over one million Coloradans experience a mental health or substance use disorder each year, yet less than half of the adult population in this state receives the care it needs;
(II) It is well documented that access to appropriate treatments, including medication, can lead to better outcomes for individuals dealing with these diagnoses;
(III) For this reason, policies that restrict access to medications lead to poorer outcomes and increased health-care costs;
(IV) Pharmacists also play an important role in improving access to treatments for serious mental illness and substance use disorders; and
(V) The use of extended-release injectable medications for serious mental illness and substance use disorders has research-proven clinical benefits compared to oral medications, including medication adherence and significant delay and reduction in relapse, which decreases criminal recidivism and emergency room visits for patients from vulnerable populations, particularly those experiencing homelessness.
(b) Therefore, the general assembly declares that access to these treatments through a pharmacy benefit under the medical assistance program will improve access to mental health providers by allowing pharmacists to dispense, administer, and be reimbursed for these important and effective medications.
(2) A pharmacist or pharmacy that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders may seek reimbursement for those medications under the medical assistance program either as a pharmacy benefit or as a medical benefit.
Source: L. 2021: Entire section added, (HB 21-1275), ch. 470, p. 3377, � 1, effective September 7.
25.5-5-512.5. Medications for opioid use disorder - pharmacists - reimbursement - definition. (1) As used in this section, unless the context otherwise requires, medications for opioid use disorder or MOUD has the meaning as set forth in section 12-280-103 (27.5).
(2) The state department shall reimburse a licensed pharmacist for prescribing or administering medications for opioid use disorder, if the pharmacist is authorized pursuant to article 280 of title 12, at a rate equal to the reimbursement provided to a physician, physician assistant, or advanced practice registered nurse for the same services.
(3) The state department shall seek any federal authorization necessary to implement this section.
Source: L. 2024: Entire section added, (HB 24-1045), ch. 470, p. 3289, � 25, effective August 7.