SB 13-277 Summary

• Creates a standardized prior authorization process for drug benefits that all Colorado carriers and pharmacy benefit management firms must use starting January 1, 2015.

• Establishes timeframes for prior authorization decisions: two business days for electronic requests, three business days for nonurgent oral/fax/email requests, and one day for urgent requests.

• Deems prior authorization requests automatically approved if carriers fail to respond within required timeframes or comply with the standardized process.

• Requires the Insurance Commissioner to develop uniform rules by July 31, 2014, including a two-page standardized form, clinical criteria based on medical evidence, and web-based accessibility of prior authorization requirements.

• Appropriates $8,756 and 0.1 FTE to the Division of Insurance for implementation in fiscal year 2013-2014.