Title 10, Insurance
0 chapters · 1,354 sections in this title.
Colo. Rev. Stat. § 10-16-1409 Colorado prescription drug affordability advisory council - created - membership - powers and duties
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(1) (a) The Colorado prescription drug affordability advisory council is created in the division to provide stakeholder input to the board regarding the affordability of prescription drugs. The advisory council is a type 2 entity, as defined in section 24-1-105. The advisory coun…
Colo. Rev. Stat. § 10-16-141 Medication synchronization services - cost sharing for partial refills - dispensing fees
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(1) A carrier offering an individual or group health coverage plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services developed by the carrier that allow for the alignment of refill dates for a covered pers…
Colo. Rev. Stat. § 10-16-1410 Use of savings - report - rules
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(1) Any savings generated for a health benefit plan that are attributable to the establishment of an upper payment limit established by the board pursuant to section 10-16-1407 must be used by the carrier that issues the health benefit plan to reduce costs to consumers, prioritiz…
Colo. Rev. Stat. § 10-16-1411 Unlawful acts - enforcement - penalties
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(1) On and after January 1, 2022, it is unlawful for any person to purchase or reimburse a payer for a prescription drug for which the board has established an upper payment limit pursuant to section 10-16-1407 at an amount that exceeds the upper payment limit established by the …
Colo. Rev. Stat. § 10-16-1412 Notice of withdrawal of prescription drugs with upper payment limits required - rules - penalty
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(1) Any manufacturer that intends to withdraw from sale or distribution within the state a prescription drug for which the board has established an upper payment limit pursuant to section 10-16-1407 shall provide a notice of withdrawal in writing at least one hundred eighty days …
Colo. Rev. Stat. § 10-16-1413 Optional participating plans - notice of election to participate required
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An optional participating plan that elects to subject its purchases of or payer reimbursements for prescription drugs in Colorado to the requirements of this part 14 shall notify the commissioner in writing within thirty days after such election.
Colo. Rev. Stat. § 10-16-1414 Reports
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(1) Notwithstanding section 24-1-136 (11)(a), on or before July 1, 2023, and on or before July 1 each year thereafter, the board shall submit a report to the governor, the health and insurance committee of the house of representatives, and the health and human services committee …
Colo. Rev. Stat. § 10-16-1415 Exemption - prescription drugs derived from cannabis
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Notwithstanding any provision of this part 14 to the contrary, the board has no authority to perform an affordability review of, or to establish an upper payment limit for, any prescription drug that is derived in whole or in part from cannabis. Source: L. 2021: Entire part added…
Colo. Rev. Stat. § 10-16-1416 Repeal of part
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This part 14 is repealed, effective September 1, 2031. Before the repeal, the functions of the board are scheduled for review in accordance with section 24-34-104. Source: L. 2021: Entire part added, (SB 21-175), ch. 240, p. 1276, � 2, effective June 16. L. 2023: Entire section a…
Colo. Rev. Stat. § 10-16-142 Physical rehabilitation services - copayments and coinsurance - research
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(1) The Colorado commission on affordable health care created in section 25-46-103, C.R.S., shall conduct a study concerning the costs, including patient cost sharing for physical rehabilitation services. The study shall analyze costs to the health-care system, including payers a…
Colo. Rev. Stat. § 10-16-143 Single geographic rating area - individual plans - study - report - repeal. (Repealed)
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C.R.S. 10-16-143Statutes 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. § 10-16-143.5 Pharmacy reimbursement - substance use disorders - injections - patient counseling
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(1) If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section 12-280-602 to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the d…
Colo. Rev. Stat. § 10-16-144 Health-care services provided by pharmacists
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(1) Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health-care services under a specific treatment protocol provided by a pharmaci…
Colo. Rev. Stat. § 10-16-145 Step therapy - limitations - exceptions - definitions - rules
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(1) As used in this section: (a) Biosimilar has the meaning set forth in 42 U.S.C. sec. 262 (i)(2). (b) Clinical practice guidelines means a systematically developed statement to assist providers and covered persons in making decisions about appropriate health care for specific c…
Colo. Rev. Stat. § 10-16-145.5 Step therapy - prior authorization - prohibited - stage four advanced metastatic cancer - opioid prescription - definitions
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(1) Notwithstanding section 10-16-145, a carrier that provides coverage under a health benefit plan for the treatment of stage four advanced metastatic cancer shall not limit or exclude coverage under the health benefit plan for a drug that is approved by the FDA and that is on t…
Colo. Rev. Stat. § 10-16-146 Periodic updates to provider directory
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Each carrier shall, at least every thirty days, update its provider directory as posted on the carrier's website in accordance with the information contained on the websites maintained by the applicable health-care prescriber board, as that term is defined in section 12-30-104, t…
Colo. Rev. Stat. § 10-16-147 Parity reporting - commissioner - carriers - rules - examination of complaints
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(1) (a) By June 1, 2020, and by each June 1 thereafter, the commissioner shall submit a written report to the health and insurance committee and the public health care and human services committee of the house of representatives, or their successor committees, and to the health a…
Colo. Rev. Stat. § 10-16-148 Medication-assisted treatment - limitations on carriers - rules
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(1) Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary: (a) Not impose prior autho…
Colo. Rev. Stat. § 10-16-149 Commissioner report - parity effects on premiums - repeal. (Repealed)
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C.R.S. 10-16-149Statutes 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. § 10-16-150 Primary care payment reform collaborative - created - powers and duties - report - definition - repeal
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(1) The commissioner shall convene a primary care payment reform collaborative to: (a) Consult with the department of personnel, the executive director of the department of health care policy and financing, and the administrator of the Colorado all-payer health claims database de…
Colo. Rev. Stat. § 10-16-1501 Short title
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The short title of this part 15 is the Colorado 340B Prescription Drug Program Anti-discrimination Act. Source: L. 2022: Entire part added, (HB 22-1122), ch. 312, p. 2230, � 1, effective August 10.
Colo. Rev. Stat. § 10-16-1502 Legislative declaration
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(1) The general assembly declares that the purpose of this part 15 is to: (a) Prohibit a pharmacy benefit manager or carrier from imposing fees, charge backs, or other adjustments on covered entities or contract pharmacies based on their participation in the 340B drug pricing pro…
Colo. Rev. Stat. § 10-16-1503 Definitions
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As used in this part 15, unless the context otherwise requires: (1) 340B covered entity means a covered entity, as defined in section 340B (a)(4) of the federal Public Health Service Act, 42 U.S.C. sec. 256b (a)(4), as amended. (2) 340B drug means a drug purchased through the 340…
Colo. Rev. Stat. § 10-16-1504 Applicability - exclusions
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(1) This part 15 applies to any third party that reimburses 340B covered entities or contract pharmacies in this state. (2) Nothing in this part 15: (a) Prohibits a third party from maintaining differential reimbursement rates for participating and nonparticipating providers, so …
Colo. Rev. Stat. § 10-16-1505 Prohibition on 340B discrimination
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(1) A third party that reimburses a 340B covered entity or contract pharmacy for 340B drugs shall not: (a) Reimburse the 340B covered entity or contract pharmacy for a pharmacy-dispensed drug at a rate lower than the amount paid for the same drug to pharmacies similar in prescrip…
Colo. Rev. Stat. § 10-16-1506 Enforcement - rules
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(1) A third party that violates this part 15 engages in an unfair or deceptive act or practice in the business of insurance under section 10-3-1104 (1)(tt), and the act of the third party that violates this part 15 is void and unenforceable. (2) The commissioner may adopt rules a…
Colo. Rev. Stat. § 10-16-151 Cost sharing in prescription insulin drugs - limits - definition - rules
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(1) As used in this section, unless the context otherwise requires, “prescription insulin drug” means a prescription drug, as defined in section 12-280-103 (42), that contains insulin and is used to treat diabetes. (2) A carrier that provides coverage for prescription insulin dru…
Colo. Rev. Stat. § 10-16-152 HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal
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(1) A carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a pharmacist may, pursuant to section 12-280-125.7, prescribe or dispense an HIV prevention drug. (2) Before July 1, 2027, a carrier shall not require a covered perso…
Colo. Rev. Stat. § 10-16-153 Coverage for opioid antagonists provided by a hospital - definition
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(1) As used in this section, unless the context otherwise requires, “opioid antagonist” has the same meaning as set forth in section 12-30-110 (7)(d). (2) A carrier that provides coverage for opioid antagonists pursuant to the terms of a health coverage plan the carrier offers sh…
Colo. Rev. Stat. § 10-16-154 Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcement
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(1) A carrier that has a contract with a physical therapist, an occupational therapist, a chiropractor, or an acupuncturist shall not: (a) Prohibit the physical therapist, occupational therapist, chiropractor, or acupuncturist from providing a covered person information on the am…
Colo. Rev. Stat. § 10-16-155 Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - rate filings - repeal
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(1) On or before November 1, 2022, the division shall retain by contract one or more entities that have experience in actuarial reviews, health-care policy, and health equity, referred to in this section as the “contractors”, for the purpose of performing actuarial reviews of leg…
Colo. Rev. Stat. § 10-16-155.5 Actuarial review of doula services - report - definition
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(1) The division shall contract with an independent entity to conduct an actuarial review of the potential health-care costs and benefits of including coverage for doula services for pregnant and postpartum persons covered by health benefit plans. (2) The division shall present t…
Colo. Rev. Stat. § 10-16-156 Prescription drugs - rebates - consumer cost reduction - point of sale - study - report - rules - definitions
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(1) As used in this section, unless the context otherwise requires: (a) “Discount” means price reductions or concessions, including base price concessions or other contractual agreements made by a manufacturer or its affiliate, that reduce payment or liability for prescription dr…
Colo. Rev. Stat. § 10-16-157 Alternative payment model parameters - parameters to include an aligned quality measure set - primary care providers - requirement for carriers to submit alternative payment models to the division - legislative declaration - report - rules - definitions
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(1) Legislative declaration. The general assembly hereby finds and declares that:(a) Fee-for-service health-care payment models have long been criticized for incentivizing a higher volume of health-care services rather than a greater value, perpetuating health disparities by fail…
Colo. Rev. Stat. § 10-16-158 Treatment of sexually transmitted infection - cost sharing - rules - definition
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(1) For health benefit plans issued or renewed on or after January 1, 2025, if the treatment of a sexually transmitted infection, as defined in section 25-4-402 (10), is a covered service, the health benefit plan must provide the coverage without deductibles, copayments, coinsura…
Colo. Rev. Stat. § 10-16-159 Coverage for sterilization services - cost sharing
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(1) For health benefit plans issued or renewed on or after January 1, 2025, if sterilization services are a covered service, the health benefit plan must provide the coverage regardless of the covered person's sex or gender and without deductibles, copayments, coinsurance, annual…
Colo. Rev. Stat. § 10-16-160 Cost sharing - prescription epinephrine - limits - rules - definition
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(1) As used in this section, unless the context otherwise requires, “epinephrine auto-injector” has the same meaning as set forth in section 12-280-142 (1)(c). (2) For health coverage plans issued or renewed on or after January 1, 2024, if a carrier provides coverage for prescrip…
Colo. Rev. Stat. § 10-16-161 Calculation of contribution to out-of-pocket and cost-sharing requirements - exception - definition - rules
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(1) (a) When calculating a covered person’s overall contribution to an out-of-pocket maximum or cost-sharing requirement under the covered person’s health benefit plan, a carrier or PBM shall include any amount paid by the covered person or by another person on behalf of the cove…
Colo. Rev. Stat. § 10-16-162 Prohibition on discrimination for coverage based solely on natural medicine consumption - definitions
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(1) A carrier that offers, issues, or renews a health benefit plan shall not, solely on the basis of a person’s consumption of natural medicine or natural medicine product: (a) Decline or limit coverage of a person; or (b) Penalize a covered person or reduce or limit coverage for…
Colo. Rev. Stat. § 10-16-163 Contracts - health benefit plans - pharmacy benefit managers - policyholders - transparency requirements - rules - definitions
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(1) For a contract between a carrier or pharmacy benefit manager and a certificate holder or policyholder that is issued or renewed on or after January 1, 2025, the amount charged by the carrier or PBM to the certificate holder or policyholder for a prescription drug dispensed to…
Colo. Rev. Stat. § 10-16-164 Hospital facility fee report - data collection
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The commissioner is authorized to collect from a carrier offering a health benefit plan information specified in section 25.5-4-216, if available, for purposes of facilitating the development of the report relating to facility fees. Source: L. 2023: Entire section added, (HB 23-1…
Colo. Rev. Stat. § 10-16-165 Dental coverage plans - dental loss ratio - rules - definitions
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(1) As used in this section, unless the context otherwise requires: (a) Community benefit expenditure means an expenditure for an activity or program, or to an organization that seeks to achieve the objectives of improving access to dental services and enhancing dental public hea…
Colo. Rev. Stat. § 10-16-166 Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules
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(1) (a) Every health benefit plan subject to part 2, 3, or 4 of this article 16, except those described in section 10-16-102 (32)(b), shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or…
Colo. Rev. Stat. § 10-16-167 Medical aid-in-dying - carrier prohibitions
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(1) A carrier shall not: (a) Deny or alter benefits otherwise available to a covered individual with a terminal disease based on the availability of medical aid-in-dying pursuant to article 48 of title 25. (b) Attempt to coerce an individual with a terminal disease to make a requ…
Colo. Rev. Stat. § 10-16-168 Carriers - health care - price transparency - rules - legislative declaration - definitions
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(1) Legislative declaration. (a) The general assembly finds and declares that: (a) (I) The federal “Patient Protection and Affordable Care Act”, Pub.L. 111-148, was enacted on March 23, 2010, and the federal “Health Care and Education Reconciliation Act of 2010”, Pub.L. 111-152, …
Colo. Rev. Stat. § 10-16-169 Carriers - prescription drug coverage - transparency
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Beginning July 1, 2025, and on or before each July 1 thereafter, each carrier shall submit to the commissioner, in the same form and manner as submitted to the United States secretary of health and human services, information required by federal pharmacy benefit and drug cost rep…
Colo. Rev. Stat. § 10-16-170 Delivery of notices and documents by electronic means - definitions - consent required - withdrawal of consent - employers - immunity from liability - posting of plans and endorsements on carrier website - applicability - rules
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(1) As used in this section, unless the context otherwise requires: (a) “Delivered by electronic means” means: (I) Delivery to an electronic mail address at which a party has consented to receive notices or documents; or (II) Posting on an electronic network, site, or consumer po…
Colo. Rev. Stat. § 10-16-200.3 Definitions
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As used in this part 2, unless the context otherwise requires: (1) Industrial sickness and accident insurance means sickness and accident insurance under individual policies for which the premium is payable weekly and includes any such policy which covers sickness only or acciden…
Colo. Rev. Stat. § 10-16-201 Form and content of individual sickness and accident insurance policies
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(1) No such policy shall be delivered or issued for delivery in this state unless: (a) The entire money and other considerations therefor are expressed therein; and (b) The time at which insurance takes effect and terminates is expressed therein; and (c) It purports to insure onl…
Colo. Rev. Stat. § 10-16-201.5 Renewability of health benefit plans - modification of health benefit plans. (Repealed)
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C.R.S. 10-16-201.5Statutes 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 Servic…