Title 10, Insurance
0 chapters · 1,354 sections in this title.
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 (Repealed)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 (Repealed)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 (Repealed)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…
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…