Colorado § 25.5-5-501 Providers - drug reimbursement

Colorado Statutes

§ 25.5-5-501 — Providers - drug reimbursement

Colorado·Title 25.5 Health·Art. Colorado Medical Assistance Act -

(1)(a) As to drugs for which payment is made, the state board's rules for payment must include the requirement that the generic equivalent of a brand-name drug be prescribed if the generic equivalent is a therapeutic equivalent to the brand-name drug, except when reimbursement to the state for a brand-name drug makes the brand-name drug less expensive than the cost of the generic equivalent. The state department shall grant an exception to this requirement if the patient has been stabilized on a medication and the treating physician, or a pharmacist with the concurrence of the treating physician, is of the opinion that a transition to the generic equivalent of the brand-name drug would be unacceptably disruptive. The requirements of this subsection

(1)do not apply to medications

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(1) (a) As to drugs for which
payment is made, the state board's rules for payment must include the requirement
that the generic equivalent of a brand-name drug be prescribed if the generic
equivalent is a therapeutic equivalent to the brand-name drug, except when
reimbursement to the state for a brand-name drug makes the brand-name drug less
expensive than the cost of the generic equivalent. The state department shall grant
an exception to this requirement if the patient has been stabilized on a medication
and the treating physician, or a pharmacist with the concurrence of the treating
physician, is of the opinion that a transition to the generic equivalent of the brand-name drug would be unacceptably disruptive. The requirements of this subsection
(1) do not apply to medications for the treatment of behavioral or mental health
disorders, cancer, epilepsy, or human immunodeficiency virus and acquired immune
deficiency syndrome.

(b) The provisions of this subsection (1) shall apply to fee-for-service and
primary care physician program recipients.

(2) It is the general assembly's intent that requiring the use of a generic
equivalent of a brand-name drug will produce savings within the state's medicaid
program. The state department, therefore, is authorized to use savings in the
medical services premiums appropriations to fund the administrative review
process required by subsection (1) of this section.

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Legislative History

Source: L. 2006: Entire article added with relocations, p. 1904, � 7, effective July 1. L. 2013: (1)(a) amended, (HB 13-1266), ch. 217, p. 992, � 63, effective May 13. L. 2017: (1)(a) amended, (SB 17-242), ch. 263, p. 1329, � 205, effective May 25.