Advocacy in Colorado

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State Fact Sheet 
Find out how arthritis affects people in Colorado and what you can do to make a difference. 

State of Your Health 
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. Please be sure to view our Colorado Department of Insurance fact sheet that gives instructions on how to appeal, request an external review or file a complaint with your insurance commissioner.

What is step therapy?   

Step therapy is a practice used by insurers that requires people with arthritis to try lower-cost medications before permitting more expensive treatments, even when the doctor wants to prescribe them. In other words, more expensive and effective drugs can only be prescribed if the cheaper ones prove ineffective.   

How does this new law address step therapy in Colorado?  

In 2017, Colorado passed legislation to address step therapy and the law went into effect in late 2017.  This new law increases the ability of the patient’s health care provider, not insurance company, to make important decisions about a patient’s treatment.  The insurer will not be allowed to require patients to go through step therapy if they already completed step therapy for the same drug, either with their current or former insurance provider, and the drug was discontinued due to lack of efficacy or effectiveness, diminished effect or adverse event.    

Which patients will benefit from this new law?  

This law is not applicable to patients who have Medicare, Medicaid or ERISA-protected, self-insured plans.  To learn if you are covered, contact your insurer and provide your policy number.    

What should I do if I experience this barrier to care in  Colorado?  

If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Colorado Division of Insurance one pager.