CO| The Colorado Division of Insurance has released the Amended Regulation 4-2-73 (3 CCR 702-4), effective September 30, 2026, that requires all carriers marketing or issuing individual and group health benefit plans in Colorado — excluding grandfathered plans and short-term limited duration policies — to cover FDA-approved HIV pre-exposure prophylaxis (PrEP) medications with no copayment or cost-sharing for individuals indicated for PrEP under USPSTF criteria, as determined by the prescribing provider or pharmacist (§ 12-280-125.7, C.R.S.), including sexually active adults and adolescents weighing at least 35 kg with specified risk factors, people who inject drugs, those engaging in transactional sex, transgender individuals, and anyone requesting PrEP who may have undisclosed risk behaviors. Carriers must also cover associated baseline and monitoring services cost-free from participating providers — HIV, hepatitis B and C, creatinine/eCrCl or eGFR, pregnancy, and STI testing plus STI and adherence counseling, along with related office visits when preventive care is the visit’s primary purpose and isn’t billed separately — and may not use medical management to steer patients toward one PrEP formulation, limit service frequency or the number of PrEP starts inconsistent with USPSTF recommendations, impose step therapy or prior authorization before a pharmacist or provider prescribes and dispenses PrEP (§ 10-16-152, C.R.S.), or add utilization management that restricts access; non-pharmacist provider PrEP requests must be treated as urgent prior authorization requests under Regulation 4-2-49. The rule incorporates the USPSTF A and B Recommendations as published on its effective date, includes a severability clause, and authorizes enforcement through civil penalties, cease and desist orders, and license suspension or revocation — this being the second amendment following the original January 1, 2021 rule and the March 2, 2022 version.
Click here to see CO Amended Regulation 4-2-73 (3 CCR 702-4)