CO| Amended Regulation 4-2-49, from the Colorado Division of Insurance, establishes requirements for prescription drug prior authorization processes. The regulation, effective March 30, 2025, applies to all carriers offering health benefit plans with prescription drug benefits in Colorado.
Key points:
- A standardized form for prior authorization requests must be used, with specific timelines for processing urgent and non-urgent requests.
- Special exception processes are required for non-formulary drug authorization requests in non-grandfathered individual and small group health benefit plans.
- Carriers must provide detailed notifications for both approvals and denials of prior authorization requests.
- Beginning January 1, 2026, prior authorization approvals will be valid for at least one year from the date of approval.
- Additional requirements are specified for certain prescription drugs, including those for substance use disorders and chronic maintenance drugs.
Please note that Regulation 4-2-101 and Regulation 4-2-102 have been withdrawn to allow for additional time to review the timelines and requirements of HB24-1149 (Prior Authorization Requirements Alternatives).
The current version of Regulation 4-2-49 will remain in effect.