HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal

(1) A carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a pharmacist may, pursuant to section 12-280-125.7, prescribe or dispense an HIV prevention drug.

(2) Before July 1, 2027, a carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a provider may, acting within the provider's scope of practice, prescribe or dispense any drug approved by the FDA and used for the treatment or prevention of HIV that is included on the carrier's prescription drug formulary as of March 1, 2023.

(3) (a) The division shall contract with one or more entities to conduct a study that includes qualitative patient and provider experience information and an actuarial review to consider the predicted cost and health impacts of removing the requirement for a covered person to undergo step therapy or to receive prior authorization before a provider may, acting within the provider's scope of practice, prescribe or dispense a drug for the treatment of HIV. In conducting the study, the entity contracted to perform the study must consult with community organizations led by people living with HIV. The division shall provide the completed study to the general assembly no later than October 1, 2026.

(b) This subsection (3) is repealed, effective July 1, 2027.