Over the past several years, Coloradans living with chronic health conditions—including MS—have spoken up about barriers to care. Thanks to that advocacy, new state laws now protect patients in Colorado-regulated insurance plans (look for “CO-DOI” on your card) and Colorado Medicaid (Health First Colorado). These laws are designed to make care more affordable and ensure you get the treatments your doctor recommends.
Key Protections You Should Know About
- Co-Pay Accumulator Programs: These programs prevented copay assistance (from nonprofits or drug manufacturers) from counting toward your deductible or out-of-pocket maximum. This practice is now illegal in Colorado-regulated plans as of January 1, 2025. If you’re still paying more because of a Co-Pay Accumulator, your insurance may not be following the law.
- Step Therapy (“Fail First” Policies): State regulated insurance plans can no longer require you to try and “fail” on certain medications before covering the one your doctor prescribes—if you meet certain conditions, like having already tried the drug before, being stable on your current treatment, or if the required drug is unsafe or ineffective for you.
What You Can Do
- If you believe your plan is using a co-pay accumulator or step therapy in ways that violate the law, file a complaint.
- For state-regulated plans: File with the Colorado Division of Insurance (DOI).
- For Medicaid: File a grievance with Health First Colorado (HCPF).
For resources on how to file a complaint and to learn more from our friends at the Chronic Care Collaborative, please visit their website here: Know Your Rights – Chronic Care Collaborative.
