<Text of section effective Jan. 1, 2023. See, also, text of section 10-16-145.5 effective until Jan. 1, 2023.>
(1)(a) 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 the carrier's
prescription drug formulary by mandating that a covered person with stage four advanced
metastatic cancer undergo step therapy if the use of the approved drug is consistent
(I) The FDA-approved indication or the National Comprehensive Cancer Network drugs
and biologics compendium indication for the treatment of stage four advanced metastatic
(II) Peer-reviewed medical literature.
(b) As used in this subsection (1), “stage four advanced metastatic cancer” means cancer that has spread from the primary or original site of the cancer to
nearby tissues, lymph nodes, or other parts of the body.
(2)(a) Notwithstanding section 10-16-145, a carrier that provides prescription drug benefits shall:
(I) Provide coverage for at least one atypical opioid that has been approved by the
FDA for the treatment of acute or chronic pain at the lowest tier of the carrier’s
drug formulary and not require step therapy or prior authorization, as defined in
section 10-16-112.5(7)(d), for that atypical opioid; and
(II) Not require step therapy for the prescription and use of any additional atypical
opioid medications that have been approved by the FDA for the treatment of acute or
(b) As used in this subsection (2), “atypical opioid” means an opioid agonist with a documented safer side-effect profile and less risk
of addiction than older opium-based medications.
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