C.R.S. Section 25.5-5-512
Pharmacy benefit

  • mental health and substance use disorders
  • legislative declaration

(1)

Intentionally left blank —Ed.

(a)

The general assembly finds and declares that:

(I)

It is estimated that over one million Coloradans experience a mental health or substance use disorder each year, yet less than half of the adult population in this state receives the care it needs;

(II)

It is well documented that access to appropriate treatments, including medication, can lead to better outcomes for individuals dealing with these diagnoses;

(III)

For this reason, policies that restrict access to medications lead to poorer outcomes and increased health-care costs;

(IV)

Pharmacists also play an important role in improving access to treatments for serious mental illness and substance use disorders; and

(V)

The use of extended-release injectable medications for serious mental illness and substance use disorders has research-proven clinical benefits compared to oral medications, including medication adherence and significant delay and reduction in relapse, which decreases criminal recidivism and emergency room visits for patients from vulnerable populations, particularly those experiencing homelessness.

(b)

Therefore, the general assembly declares that access to these treatments through a pharmacy benefit under the medical assistance program will improve access to mental health providers by allowing pharmacists to dispense, administer, and be reimbursed for these important and effective medications.

(2)

A pharmacist or pharmacy that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders may seek reimbursement for those medications under the medical assistance program either as a pharmacy benefit or as a medical benefit.

Source: Section 25.5-5-512 — Pharmacy benefit - mental health and substance use disorders - legislative declaration, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-25.­5.­pdf (accessed Oct. 20, 2023).

25.5‑5‑101
Mandatory provisions - eligible groups - rules - repeal 25.5‑5‑102
Basic services for the categorically needy - mandated services 25.5‑5‑103
Mandated programs with special state provisions - rules 25.5‑5‑104
Qualified medicare beneficiaries 25.5‑5‑105
Qualified disabled and working individuals 25.5‑5‑201
Optional provisions - optional groups - rules - repeal 25.5‑5‑202
Basic services for the categorically needy - optional services 25.5‑5‑203
Optional programs with special state provisions - repeal 25.5‑5‑204
Presumptive eligibility - pregnant person - children - long-term care - state plan 25.5‑5‑204.5
Continuous eligibility - children 25.5‑5‑206
Medicaid buy-in program - disabled children - disabled adults - federal authorization - rules 25.5‑5‑207
Adult dental benefit - adult dental fund - creation - legislative declaration 25.5‑5‑208
Additional services - training - grants - screening, brief intervention, and referral 25.5‑5‑301
Clinic services 25.5‑5‑302
Clinic services - children and pregnant women - utilization of certain providers 25.5‑5‑303
Private-duty nursing 25.5‑5‑304
Hospice care 25.5‑5‑305
Pediatric hospice care - legislative declaration - federal authorization - rules - fund 25.5‑5‑307
Child mental health treatment and family support program 25.5‑5‑308
Breast and cervical cancer prevention and treatment program - creation - legislative declaration - definitions - funds - repeal 25.5‑5‑309
Pregnant women - needs assessment - referral to treatment program - definition 25.5‑5‑310
Treatment program for high-risk pregnant and parenting women - cooperation with private entities - definition 25.5‑5‑311
Treatment program for high-risk pregnant and parenting women - data collection 25.5‑5‑312
Treatment program for high-risk pregnant and parenting women - extended coverage - federal approval 25.5‑5‑314
Substance use disorder treatment for Native Americans - federal approval 25.5‑5‑315
Acceptance of gifts, grants, and donations - Native American substance abuse treatment cash fund 25.5‑5‑316
Legislative declaration - state department - disease management programs authorization - report 25.5‑5‑318
Health services - provision by school districts - repeal 25.5‑5‑319
Family planning pilot program - rules - federal waiver - repeal 25.5‑5‑320
Telemedicine - reimbursement - disclosure statement - rules - definition 25.5‑5‑321
Telemedicine - home health care - home health telemedicine cash fund - rules - repeal 25.5‑5‑321.5
Telehealth - interim therapeutic restorations - reimbursement - definitions 25.5‑5‑322
Over-the-counter medications - rules 25.5‑5‑323
Complex rehabilitation technology - no prior authorization - metrics - report - rules - legislative declaration - definitions 25.5‑5‑324
Nonemergency medical transportation - urgent and secure transportation need - report - repeal 25.5‑5‑325
Residential and inpatient substance use disorder treatment - medical detoxification services - federal approval - performance review report 25.5‑5‑326
Access to clinical trials - definitions 25.5‑5‑327
Eligible peer support services - reimbursement - definitions 25.5‑5‑328
Secure transportation for behavioral health crises - benefit - funding 25.5‑5‑329
Family planning services - federal authorization - rules - definitions 25.5‑5‑330
Screening for perinatal mood and anxiety disorder 25.5‑5‑331
Federally qualified health center - clinical pharmacy services - reimbursement - rules 25.5‑5‑332
Therapy using equine movement - federal authorization - definition 25.5‑5‑333
Primary care and behavioral health statewide integration grant program - creation - report - definition - repeal 25.5‑5‑334
Community health worker services - federal authorization - reporting - rules - definition 25.5‑5‑335
Continuous medical coverage for children and adults feasibility study - federal authorization - rules - report - definition 25.5‑5‑336
Prohibition on using the body mass index or ideal body weight - medical necessity criteria 25.5‑5‑401
Short title 25.5‑5‑402
Statewide managed care system - rules - definitions - repeal 25.5‑5‑403
Definitions 25.5‑5‑406.1
Required features of statewide managed care system 25.5‑5‑408
Capitation payments - availability of base data - adjustments - rate calculation - capitation payment proposal - preference - assignment of medicaid recipients - definition 25.5‑5‑410
Data collection for managed care programs 25.5‑5‑412
Program of all-inclusive care for the elderly - services - eligibility - legislative declaration - rules - definitions 25.5‑5‑414
Telemedicine - legislative intent 25.5‑5‑415
Medicaid payment reform and innovation pilot program - legislative declaration - creation - selection of payment projects - report - rules 25.5‑5‑418
Primary care provider sustainability fund - creation - use of fund 25.5‑5‑419
Accountable care collaborative - reporting - rules 25.5‑5‑420
Advancing care for exceptional kids 25.5‑5‑421
Parity reporting - state department - public input 25.5‑5‑422
Medication-assisted treatment - limitations on MCEs - definition 25.5‑5‑423
Independent review organization - review denial of residential and inpatient substance use disorder treatment claims - contract 25.5‑5‑424
Residential and inpatient substance use disorder treatment - MCE standardized utilization management process - medical necessity - report 25.5‑5‑425
Audit of MCE denials for residential and inpatient substance use disorder treatment authorization - report 25.5‑5‑500.3
Authorization to bill third party 25.5‑5‑501
Providers - drug reimbursement 25.5‑5‑502
Unused medications - reuse - rules - definition 25.5‑5‑503
Prescription drug benefits - authorization - dual-eligible participation 25.5‑5‑504
Providers of pharmaceutical services 25.5‑5‑505
Prescribed drugs - mail order - rules 25.5‑5‑506
Prescribed drugs - utilization review 25.5‑5‑507
Prescription drug information and technical assistance program - rules 25.5‑5‑509
Substance use disorder - prescription drugs - opiate antagonist 25.5‑5‑510
Pharmacy reimbursement - substance use disorder - injections 25.5‑5‑511
Reimbursement for pharmacists’ services - legislative declaration 25.5‑5‑512
Pharmacy benefit - mental health and substance use disorders - legislative declaration 25.5‑5‑513
Pharmacy benefits - prescription drugs - rebates - analysis 25.5‑5‑514
Prescription drugs used for treatment or prevention of HIV - prohibition on utilization management - definition 25.5‑5‑515
Pharmacy reimbursement - vaccine administration to children - legislative declaration 25.5‑5‑516
Serious mental illness - prescribed drugs 25.5‑5‑801
Legislative declaration 25.5‑5‑802
Definitions 25.5‑5‑803
High-fidelity wraparound services for children and youth - federal approval - reporting 25.5‑5‑804
Integrated funding pilot
Green check means up to date. Up to date

Current through Fall 2024

§ 25.5-5-512’s source at colorado​.gov