CO| The Colorado Insurance Division has amended Regulation 4-2-75 establishing detailed annual reporting requirements for health insurance carriers on their coverage of medication-assisted treatment (MAT) for substance use disorders, under the authority of specified Colorado insurance statutes. It applies to all carriers offering individual, small group, and large group health benefit plans in Colorado, including non-grandfathered plans, short-term limited duration policies, and student health coverage, and clarifies key definitions such as carrier, health benefit plan, MAT, substance use disorder, and related federal references. The regulation incorporates federal parity standards by reference, includes a severability clause, and states that noncompliance may lead to sanctions such as fines, cease and desist orders, or license actions.
- Carriers must submit an annual SERFF filing titled “Annual Medication-Assisted Treatment (MAT) Reporting (4-2-75)” by April 1 each year, reporting prior-year data on network capacity, enrollee utilization, and MAT medication coverage, including coverage administered through TPAs.
- Required data include: numbers and locations of SUD providers and OTPs by network; unique enrollees using SUD services; prescription volumes and utilization management (e.g., prior authorization, step therapy, quantity limits) applied to MAT medications; formulary placement ensuring at least one FDA-approved SUD medication on the lowest-cost tier; and narrative descriptions of policies to ensure sufficient access and network sufficiency, with supporting documentation of prior authorization and utilization management procedures or attestations if such requirements are not used. The amended regulation becomes effective January 30, 2026, and retains a history noting the original regulation effective June 15, 2021.
Click here to see CO Amended Regulation 4-2-75