MARCH 9, 2023
Dear (Chair) and Members of the Health & Insurance Committee
Thank you for the opportunity to provide this written testimony to the House Health & Insurance Committee on HB23-1225, the PDAB Modernization Bill.
In 2021, I was one of dozens of everyday Coloradans, doctors, hospitals, medical providers and other stakeholders to testify in opposition to the original PDAB bill, SB21-175.
The concerns raised then about embarking on an ill-advised and unproven program where the state controls the price of prescription medicines lasted well into the night. Questions were never answered on how the state would ensure that patients in Colorado would receive real, tangible savings on prescription drugs, how the state would guarantee that patient access to life-saving medicines would not be compromised, and how the PDAB law would not put our health providers in the horrific vice of having either to deny patients the drugs they need or violate the law.
Twenty months and over $1.6 million in taxpayer dollars, these questions remain. The PDAB has not even brought up a single prescription drug for consideration of the upper payment limit (UPL), the supposed silver bullet for how costs will be lowered. Instead of producing real results for struggling Colorado drug consumers, the state had to go back for an additional $260,000 on top of the original appropriation.
Inexplicably, we are now looking at the introduction of HB23-1225 as a massive expansion of the PDAB program and reach. The bill removes the two key guardrails put in Sb-175 that legislators agreed to as a pledge to help ensure that, if nothing else, the potential damage of the PDAB program can be mitigated. Instead, HB23-1225 gives PDAB “carte blanche” to set a UPL for any drug they choose, as opposed to the twelve drug limit and doubles the sunset period from five to ten years.
We should be going in the opposite direction. Before taking any more action or gaining more control, the state legislature and the executive branch should be requiring that the PDAB board answer questions about the cost/benefit being promised to Colorado patients:
- What level of savings can patients expect to see from implementation of PDAB policies and when can they expect to see them? Will patients see any reduction in their out-of-pocket costs?
- How do Colorado patients and their families get assurance that the backward logic of the UPL does not result in patients being denied access to hundreds of medications because providers won’t be allowed to access the drugs or face legal action if they do?
- What alternatives will be available to patients if a needed medication is denied to them?
- To what extent would PDAB exacerbate the already growing health inequities between high and low-income patients when those with means can travel outside Colorado for a drug not available under the UPL, and those without means will have a harder time doing so?
- How can the state legislature, research staff, and HCPF leadership possibly justify the notion that no additional fiscal support will be required for a DOUBLING of PDAB’s sunset term, when the current spend rate for the program is $81,000 a month. Will the four, full-time state employees now assigned to PDAB go away? Will the board not spend a penny during the course of its five-year extension?
Unfortunately for Colorado patients, families and taxpayers, these questions only begin to tackle the looming risks and costs posed by the PDAB concept. Add to those the fundamental violation of our free market system that having a government price-setting board represents, and the chance of a nightmare scenario facing the state’s patients and taxpayers becomes all too real.
I urge the state legislature to vote no on HB23-1225 and instead conduct a rigorous review of the hazards and harms PDAB may pose to Coloradans and address ways to ensure patients already struggling under high healthcare costs aren’t faced with further suffering.