Title 10, Insurance
0 chapters · 1,354 sections in this title.
Colo. Rev. Stat. § 10-16-122.4 Pharmacy benefits - formulary change prohibition - exceptions - enforcement - definition - rules
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(1) (a) Starting in 2024, except as provided in subsection (2) of this section, a carrier or, if a carrier uses a PBM for claims processing services or other prescription drug or device services, as those terms are defined in section 10-16-122.1, under a health benefit plan offer…
Colo. Rev. Stat. § 10-16-122.5 Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rules
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(1) A pharmacy benefit manager, a carrier, or an entity acting on behalf of a pharmacy benefit manager or a carrier that audits a pharmacy shall: (a) Give the pharmacy at least seven days’ written notice prior to commencing an audit; (b) Conduct the audit by or in consultation wi…
Colo. Rev. Stat. § 10-16-122.6 Pharmacy benefit managers - contracts with pharmacies - maximum allowable cost pricing - enforcement - rules
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(1) (a) In each contract between a pharmacy benefit manager and a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit manager, within ten days after any request, a current list of the sources used to determine maximum allowable cost pricing. The ph…
Colo. Rev. Stat. § 10-16-122.7 Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules
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(1) The short title of this section is the “Patient Drug Costs Savings Act”. (2) The general assembly hereby finds and declares that: (a) Consumers have the right to know about options to reduce the amount of money they pay at a pharmacy for prescription drugs; and (b) This secti…
Colo. Rev. Stat. § 10-16-122.8 Pharmacy benefit manager practices - agreements - fees - documentation - rules
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(1) [Editor’s note: This section is effective January 1, 2027.](1) A pharmacy benefit manager may earn income derived from the assessment of a single, flat-dollar service fee for the provision of a prescription drug, which service fee is transparently expressed in a written agree…
Colo. Rev. Stat. § 10-16-122.9 Prescription drug benefits - real-time access to benefit information - enforcement - definitions - rules
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(1) (a) Upon request of a covered person, the covered person’s provider, or a third party on behalf of the covered person or provider, a carrier or, if a carrier uses a pharmacy benefit manager for claims processing services or other prescription drug or device services under a h…
Colo. Rev. Stat. § 10-16-123 Telehealth - definitions
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(1) It is the intent of the general assembly to recognize the practice of telehealth as a legitimate means by which an individual may receive health-care services from a provider without in-person contact with the provider. (2) (a) A health benefit plan or dental plan that is iss…
Colo. Rev. Stat. § 10-16-124 Prescription information cards - legislative declaration
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(1) It is the intent of the general assembly to lessen patients' waiting times for prescriptions, to decrease administrative burdens for pharmacies, and to improve care to patients by minimizing confusion, eliminating unnecessary paperwork, and streamlining the dispensing of pres…
Colo. Rev. Stat. § 10-16-124.5 Prior authorization form - drug benefits - program - chronic maintenance drugs - rules of commissioner - definitions - repeal
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(1) (a) Notwithstanding any other provision of law but subject to paragraph (b) of this subsection (1), on and after January 1, 2015, a carrier or, if a carrier contracts with a pharmacy benefit management firm to perform prior authorization services for drug benefits, the pharma…
Colo. Rev. Stat. § 10-16-124.6 Drugs used for substance use disorder - prior authorization prohibited
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A carrier that provides coverage under a health benefit plan for a drug used to treat a substance use disorder shall not require prior authorization, as defined in section 10-16-112.5 (7)(d), for the drug based solely on the dosage amount.
Colo. Rev. Stat. § 10-16-124.7 Opioid analgesics with abuse-deterrent properties - study - definitions
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(1) The governor shall direct the Colorado consortium for prescription drug abuse prevention to study the barriers to the use of abuse-deterrent opioid analgesic drug products as a way to reduce abuse and diversion of opioid drug products. On or before January 15, 2017, the conso…
Colo. Rev. Stat. § 10-16-124.8 Colorado consortium for prescription drug abuse prevention - create process for recovery - report
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(1) The governor shall direct the Colorado consortium for prescription drug abuse prevention within the university of Colorado to: (a) Create a process with the substance abuse recovery community to develop a strategic plan that addresses the full continuum of recovery services, …
Colo. Rev. Stat. § 10-16-125 Reimbursement to nurses
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(1) In counties of the state that are neither part of a metropolitan statistical area nor a primary statistical area, a carrier offering a health benefit plan shall not discriminate between a physician and an advanced practice registered nurse not practicing under the direction o…
Colo. Rev. Stat. § 10-16-126 Fee-for-service dental plans
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(1) Notwithstanding any provision of this title to the contrary, a fee-for-service dental plan for which premiums are not charged is not subject to the provisions of this title and the offering of such a plan shall not be considered transacting the business of insurance pursuant …
Colo. Rev. Stat. § 10-16-127 Coinsurance and deductibles
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A carrier subject to the provisions of parts 2, 3, and 4 of this article may offer one or more health coverage plans that contain deductibles or coinsurance without any limitation or restriction on the maximum out-of-pocket payable by the insured. Source: L. 2003: Entire section …
Colo. Rev. Stat. § 10-16-128 Annual report to general assembly
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Notwithstanding section 24-1-136 (11)(a)(I), the commissioner shall report to the business affairs and labor committee of the house of representatives and the business, labor, and technology committee of the senate, or any successor committees, no later than October 1, 2004, and …
Colo. Rev. Stat. § 10-16-129 Health savings accounts
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Any carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article may offer a high deductible health plan that would qualify for and may be offered in conjunction with a health savings account pursuant to 26 U.S.C. sec. 223,…
Colo. Rev. Stat. § 10-16-130 Disclosure of rate increases to public entities - legislative declaration - definitions
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(1) The general assembly hereby finds, determines, and declares that variability in premiums by carriers offering health benefit coverage to a public entity present difficulties for fiscal planning for the public entity. Therefore, it is in the best interest of the state to promo…
Colo. Rev. Stat. § 10-16-1301 Short title
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The short title of this part 13 is the Colorado Standardized Health Benefit Plan Act. Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1278, � 1, effective June 16.
Colo. Rev. Stat. § 10-16-1302 Legislative declaration - intent
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(1) The general assembly, through the exercise of its powers to protect the health, peace, safety, and general welfare of the people of Colorado, hereby finds that: (a) Health insurance coverage has been demonstrated to have a positive impact on people's health outcomes as well a…
Colo. Rev. Stat. § 10-16-1303 Definitions
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As used in this part 13, unless the context otherwise requires: (1) Advisory board means the board established in section 10-16-1307. (2) Critical access hospital means a hospital that is federally certified or undergoing federal certification as a critical access hospital pursua…
Colo. Rev. Stat. § 10-16-1304 Standardized health benefit plan - established - components - rules - independent analysis - repeal
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(1) On or before January 1, 2022, the commissioner shall establish, by rule, a standardized health benefit plan to be offered by carriers in this state in the individual and small group markets. The standardized plan must: (a) Offer health-care coverage at the bronze, silver, and…
Colo. Rev. Stat. § 10-16-1305 Standardized health benefit plan - carriers required to offer - premium rates - rules
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(1) Beginning January 1, 2023, a carrier that offers: (a) An individual health benefit plan in Colorado is required to offer the standardized plan in the individual market in each county where the carrier offers an individual health benefit plan and shall offer the standardized p…
Colo. Rev. Stat. § 10-16-1305.5 Rate filings
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(1) In the rate filings required pursuant to section 10-16-107, each carrier must file rates for the standardized plan at the premium rates required in section 10-16-1305 (2). (2) In reviewing the rates for the standardized plans, the commissioner may establish uniform limits on …
Colo. Rev. Stat. § 10-16-1306 Failure to meet premium rate requirements - notice - public hearing - rules
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(1) (a) Repealed. (b) If a carrier or health-care provider anticipates that the carrier will be unable to meet network adequacy standards or the premium rate requirements in section 10-16-1305 due to a reimbursement rate dispute for the standardized plan, the carrier or health-ca…
Colo. Rev. Stat. § 10-16-1307 Advisory board - members - rules
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(1) (a) The commissioner shall consult with an advisory board to implement this part 13. The governor shall appoint the members of the advisory board on or before July 1, 2022, and shall ensure that the membership of the advisory board has demonstrated experience and expertise in…
Colo. Rev. Stat. § 10-16-1308 Federal waiver - commissioner application - use of money
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(1) On or after June 16, 2021, the commissioner may apply to the secretary of the United States department of health and human services for a state innovation waiver to waive one or more requirements of the federal act as authorized by section 1332 of the federal act to capture a…
Colo. Rev. Stat. § 10-16-1309 Standardized plan - cost shift
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(1) If the administrator of a self-funded health insurance plan voluntarily provides to the commissioner its contracted rates and any other information deemed necessary and agreed upon by the administrator and the commissioner, the commissioner may evaluate whether the rates of t…
Colo. Rev. Stat. § 10-16-131 Health care reform project - blue ribbon commission for health care reform - repeal. (Repealed)
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C.R.S. 10-16-131Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-1310 Reports required - repeal
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(1) (a) The commissioner shall contract with an independent third-party organization to prepare three separate reports as specified in subsection (1)(d) of this section, to the extent that information is available regarding the implementation of this part 13 as it relates to the …
Colo. Rev. Stat. § 10-16-1311 State measurement for accountable, responsive, and transparent (SMART) government act report
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(1) The commissioner shall report during the hearings conducted pursuant to the “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act”, part 2 of article 7 of title 2: (a) Beginning in January 2022 and each year thereafter, on the progress of the …
Colo. Rev. Stat. § 10-16-1312 Rules
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The commissioner may promulgate rules as necessary to develop, implement, and operate this part 13, including rules necessary to align state law with any federal program requirements and applicable rules. Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1293, � 1, ef…
Colo. Rev. Stat. § 10-16-1313 Severability
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If any provision of this part 13 or application thereof to any person or circumstances is judged invalid, the invalidity does not affect provisions or applications of this part 13 that can be given effect without the invalid provision or application, and to this end the provision…
Colo. Rev. Stat. § 10-16-132 Study of factors driving health care costs in Pueblo county - repeal. (Repealed)
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C.R.S. 10-16-132Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-133 Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rules
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(1) The general assembly finds and determines that consumers deserve to know the quality and cost of their health-care insurance. Health-care insurance transparency provides consumers with the information necessary, and the incentive, to choose health plans based on cost and qual…
Colo. Rev. Stat. § 10-16-134 Health-care transparency - information required - website - definition. (Repealed)
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C.R.S. 10-16-134Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-135 Health coverage plan information cards - rules - standardization - contents
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(1) (a) The commissioner shall adopt rules requiring every carrier providing a health benefit plan to issue to covered persons to whom a health benefit plan identification card is issued a standardized printed or electronic card containing plan information. To the extent possible…
Colo. Rev. Stat. § 10-16-136 Wellness and prevention programs - individual and small group health coverage plans - voluntary participation - incentives or rewards - rules - definitions - legislative declaration - repeal. (Repealed)
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C.R.S. 10-16-136Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-137 Policy forms - explanation of benefits - standardization of forms - rules
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(1) The commissioner shall convene a group of stakeholders, including carriers, providers, and consumers, to develop a standardized format for the following regarding health benefit plans, limited benefit health insurance, and dental plans: (a) Section names and the placement of …
Colo. Rev. Stat. § 10-16-138 Pathology services - direct billing required
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(1) A clinical laboratory or physician that is located in this state or in another state, and that provides anatomic pathology services for patients in this state, shall present or cause to be presented a claim, bill, or demand for payment for these services only to: (a) The pati…
Colo. Rev. Stat. § 10-16-139 Access to care - rules - definitions
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(1) Access to obstetricians and gynecologists. A health benefit plan that is delivered, issued, renewed, or reinstated in this state on or after January 1, 2014, that provides coverage for reproductive health or gynecological care shall not be delivered, issued, renewed, or reins…
Colo. Rev. Stat. § 10-16-140 Grace periods - premium payments - rules
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(1) For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons receiving a subsidy under the federal act, the commissioner shall establish, by rule that complies with federal law, a requirement that all …
Colo. Rev. Stat. § 10-16-1401 Definitions
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As used in this part 14, unless the context otherwise requires: (1) Advisory council means the Colorado prescription drug affordability advisory council created in section 10-16-1409. (2) Affordability review means an affordability review of a prescription drug performed by the b…
Colo. Rev. Stat. § 10-16-1402 Colorado prescription drug affordability review board - created - membership - terms - conflicts of interest
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(1) The Colorado prescription drug affordability review board is created in the division. The board is a type 1 entity, as defined in section 24-1-105. The board exercises its powers and performs its duties and functions under the department of regulatory agencies and is allocate…
Colo. Rev. Stat. § 10-16-1403 Colorado prescription drug affordability review board - powers and duties - rules
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(1) To protect Colorado consumers from excessive prescription drug costs, the board shall: (a) Collect and evaluate information concerning the cost of prescription drugs sold to Colorado consumers, as described in section 10-16-1405; (b) Perform affordability reviews of prescript…
Colo. Rev. Stat. § 10-16-1404 Colorado prescription drug affordability review board meetings - required to be public - exceptions
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(1) The board shall hold its first meeting within six weeks after all of the board members are appointed and shall meet at least every six weeks thereafter to review prescription drugs; except that the chair may cancel or postpone a meeting if the board has no prescription drugs …
Colo. Rev. Stat. § 10-16-1405 Colorado prescription drug affordability review board - reports from carriers and pharmacy benefit management firms required - confidential materials
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(1) Beginning in the 2022 calendar year, for all prescription drugs dispensed at a pharmacy in this state and paid for by a carrier pursuant to a health benefit plan issued under part 2, 3, or 4 of this article 16 during the immediately preceding calendar year, including brand-na…
Colo. Rev. Stat. § 10-16-1406 Colorado prescription drug affordability review board - affordability reviews of prescription drugs
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(1) The board may conduct affordability reviews of prescription drugs in accordance with this section. The board shall identify, for purposes of determining whether to conduct an affordability review: (a) Any prescription drug that has: (I) A wholesale acquisition cost of three t…
Colo. Rev. Stat. § 10-16-1407 Colorado prescription drug affordability review board - upper payment limits for certain prescription drugs - rules - severability
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(1) (a) The board may establish an upper payment limit for any prescription drug for which the board has performed an affordability review pursuant to section 10-16-1406 and determined that the use of the prescription drug is unaffordable for Colorado consumers; except that: (I) …
Colo. Rev. Stat. § 10-16-1408 Colorado prescription drug affordability review board - judicial review
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(1) The following board functions are not final agency actions subject to judicial review under the “State Administrative Procedure Act”, article 4 of title 24: (a) Identification of eligible prescription drugs pursuant to section 10-16-1406 (1); (b) Selection of a prescription d…