CAFP News: Prior Authorization Reforms in Effect Jan. 1

ByAnjali Budhiraja

Beginning January 1, 2026, Colorado will implement the prior authorization reforms directed by the passage of HB24-1149. CAFP championed this piece of legislation in 2024 that will improve patient care and decrease administrative burden. Beginning in 2026, the following changes will take place:

  • Approvals will be extended from 180 days to 1 per year or length of treatment
  • Chronic maintenance drugs approval will be extended for 3 years (high-cost drugs excluded)
  • In the case of prior authorization denials, carriers are required to include which alternative service/medication would be approved
  • Carriers must remove unnecessary prior authorization requirements through an annual review 
  • Carriers’ formularies will be publicly posted
  • Prohibits surgical denials for care that was approved, but during treatment require immediate, additional, or different medically necessary care.
  • Carriers must create an alternate program to prior authorization for qualified providers for medical services & prescription drugs.

Please review your practice’s workflows to ensure these updates are made. Reach out to CAFP’s Director of Policy and Government Relations, Isabel Hinshaw at isabel@coloradoafp.org with any questions.