Over the past five years, several not-so-productive bills have passed the Colorado legislature to supposedly lower prescription drug prices. This legislative session, however, something really meaningful happened for Colorado patients.

The Colorado General Assembly passed House Bill 23-1201, which prohibits one of the many underhanded practices pharmacy benefit managers, known as “PBMs”, use to artificially inflate profits and drive up the cost of prescription medicines for everyone.

HB23-1201 was a bipartisan bill sponsored by Colorado Representatives Daugherty and Soper as well as Senators Mullica and Smallwood. The bill prohibits PBMs from further using ‘spread pricing.’ In simple terms, this is the practice of  having the PBM charge its client – an insurance company or company that self-insures its employees –  a higher price than the PBM pays the pharmacy for dispensing the same drug to the same covered member.

In other words, PBMs have been charging the equivalent of a hotel ‘resort fee,’ a meaningless mark-up that provides nothing but increased profits that in turn drives up prescription drug prices while shorting local pharmacists. It’s a lose-lose-lose scheme that our state legislature finally outlawed. The bill now sits on Gov. Polis’ desk, and we urge its immediate signing.

Last year the top PBMS — companies who claim their role is to save Americans money on the skyrocketing cost of medicines — took in $450,000,000,000. That’s $450 billion, $50 billion more than the top six drug makers earned in 2021.

They derive this windfall from an impenetrable web of rigged contracts and high-pressure tactics that would make a crime boss blush. A blizzard of reports by Congress, non-partisan groups, and industry experts have highlighted these practices and called for a massive overhaul of the PBM system.

Thankfully a hearing is set for Thursday, May 11, to consolidate PBM reform efforts and write meaningful legislation to reform the PBM’s unsavory practices.

Senators Bernie Sanders (D-VT) and William Cassidy (R-LA) are leading the charge, with Colorado Senator John Hickenlooper as a member of the HELP Committee. They need our support against the intense pressure coming from the battalion of lobbyists that we – America’s prescription drug patients – help pay for.

CHAIN backs the herculean effort to crack down on the PBM monopoly and go after the real cause of skyrocketing drug prices in America. And we urge Colorado’s US Senators Hickenlooper and Bennet to be front and center in finishing the job Congress has started.

To learn more, go here and check out our ads on Twitter:  https://twitter.com/BetterHealth4CO

Stakeholders across the state, including the American Cancer Society (“ACS”), have mobilized on this critical piece of legislation.  The bill would guarantee the availability of biomarker testing and precision medicine for cancer patients in addition to Colorado patients with other life-threatening diseases.

Data from the ACS across the United States shows a deplorable gap in accessibility to precision medicine, especially among the underserved and underinsured.  Almost 25% of patients needing these types of cutting-edge tests end up going without – risking their health – and possibly misdiagnosis, mistreatment and worse.  Most of these cases involve lack of insurance approval as the primary impediment to getting needed care.

One patient, Rebecca Givens, testified in favor of HB23-1110 and shared her story:
“I was diagnosed with an aggressive form of cancer Thanksgiving of 2019. This diagnosis was terrifying, confusing, time consuming and very expensive. It led to a year of treatment with chemotherapy, surgery and biologic therapy following surgery. And after all of this, I believed I was cancer free…”

“Then I learned at my post-cancer follow-up appointment that the values on the standard tumor marker blood test came back elevated. . . . and I was left with large out-of-pocket costs that I had to cover…”

“My doctor then told me about comprehensive biomarker testing, a highly sensitive and personalized test that could reveal if my cancer had reoccurred or if new cancer cells were present with the added benefit that the test would not show a false positive based on my rheumatoid arthritis diagnosis. I jumped at the chance to get this testing despite its very high cost that was not covered by my group health insurance plan. Being fortunate enough to have the financial resources, I immediately determined to move forward with this critical test.”

“The results of my biomarker testing were negative. I finally knew I was cancer free. Had I received comprehensive biomarker testing earlier in my cancer journey, I would have not had to endure the additional diagnostic tests and procedures, saving me precious time and stress, and reducing the cost of my care overall.”

Rebecca’s story, despite the anguish, ended well.  But how many Colorado patients may not be as fortunate to afford extra care to get to the right diagnosis?  One more is too many.

By lowering misdiagnosis and improving care, precision medicine could dramatically lower the cost of care not only in Colorado but across the United States.  For colorectal cancer alone, A 2012 study found that it is possible to increase expected overall survival while saving approximately $7,500 per patient when compared to using non-biomarker-directed treatment²⁵.  Another research project estimated that using specific biomarker testing could save more than $600 million by ensuring that only those metastatic colorectal cancer patients likely to benefit from a specific therapy would receive it.

In spite of the overwhelming public good and support of leading health and patient advocacy groups, passage of HB23-1110 is not assured.  The bill’s next stop will likely be the House Appropriations Committee.

CHAIN is urging every Coloradan to contact their state lawmakers and encourage them to support physical and financial wellbeing in our state by voting YES on HB23-1110.

• 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 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 its five-year extension?

Read Jennifer Churchfield’s written testimony re: HB23-1225 here:  https://betterhealthcareco.org/testimony-submitted-by-jennifer-churchield-hb23-1225/