Substance Use Disorder Payment And Coverage

Opioid and Other Substance Use Disorders Interim Study Committee. The bill requires all individual and group health benefit plans to provide coverage without prior authorization for a five-day supply of at least one of the federal food and drug administration-approved drugs for the treatment of opioid dependence for a first request within a 12-month period. The bill prohibits carriers from taking adverse action against a provider or from providing financial incentives or disincentives to a provider based solely on a patient satisfaction survey relating to the patient's satisfaction with pain treatment. The bill clarifies that an 'urgent prior authorization request' to a carrier includes a request for authorization of medication-assisted treatment for substance use disorders. The bill permits a pharmacy that has entered into a collaborative pharmacy practice agreement with one or more physicians to administer injectable antagonist medication for substance use disorders and receive an enhanced dispensing fee for the administration. The bill requires the Colorado medical assistance program to authorize reimbursement for at least one federal food and drug administration-approved ready-to-use opioid overdose reversal drug without prior authorization. The bill permits a pharmacy that has entered into a collaborative pharmacy practice agreement with one or more physicians to administer injectable opioid antagonist medication for substance use disorders and receive an enhanced dispensing fee under the Colorado medical assistance program for the administration. The bill requires the department of health care policy and financing and the office of behavioral health in the department of human services to establish rules that standardize utilization management authority timelines for the nonpharmaceutical components of medication-assisted treatment for substance use disorders. (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.) Read More