Weekly Policy Blog: Governor Polis’ Healthcare Legislative Package

On March 2, Governor Jared Polis held a press conference to announce a legislative package that he says will save people money on healthcare and increase transparency within the healthcare system. He emphasized that the package of bills builds on previous efforts and “will cut prescription drug costs, reduce premiums, strengthen the healthcare workforce and decrease hospital costs.” Of the nine bills the Governor highlighted, three are related to prescription drugs: HB23-1225 extends and expands the scope of the Prescription Drug Affordability Board (PDAB), HB23-1201 prohibits the practice of “spread pricing” by pharmacy benefit managers (PBMs), and HB23-1227 gives the Division of Insurance more direct oversight over PBMs. CBSA is evaluating these bills and will collaborate with partners and policymakers to advocate for policies that protect patient access and support a pro-innovation environment for life sciences in Colorado. 

Legislative Package 

Governor Polis’ package of healthcare bills includes the following nine bills, as he referred to them: 

  • HB23-1224: Reducing Premiums for Colorado Option Plans (Representatives Iman Jodeh and Kyle Brown and Senator Roberts) 
  • HB23-1225: Expanding Prescription Drug Cost Saving Measures (Representatives Chris deGruy Kennedy and Ruby Dickson and Senator Sonya Jaquez Lewis) 
  • HB23-1201: Saving Employers Money on Prescription Drug Coverage (Representatives Lindsey Daugherty and Matt Soper) 
  • HB23-1227: Holding PBMs Accountable (Representatives Iman Jodeh and David Ortiz) 
  • Ensuring Large Hospitals Invest in Our Communities to Lower Health Care Costs (Representative Judy Amabile) *Not yet introduced 
  • HB23-1226: Improving Hospital Transparency (Representatives Chris deGruy Kennedy and Matt Soper) 
  • SB23-093: Increasing Consumer Protections Medical Transactions (Senators Lisa Cutter and Sonya Jaquez Lewis and Representative Mike Weissman) 
  • SB23-004: Boosting Employment of School Mental Health Professionals (Senators Janice Marchman and Sonya Jaquez Lewis and Representatives Mary Young and Dafna Michaelson Jenet) 
  • SB23-002: Increasing Access to Community Health Services (Senators Kyle Mullica and Cleave Simpson and Speaker Julie McCluskie and Representative Mary Bradfield)

There are other notable bills related to healthcare costs as well, including HB23-1215, Limits On Hospital Facility Fees, which takes an especially aggressive approach toward the hospital industry by prohibiting hospitals from charging facility fees at their off-campus outpatient clinics or specialty centers. 

Bills Related to Prescription Drugs 

Of the nine bills the Governor highlighted, bills two, three, and four are related to prescription drugs: 

HB23-1225: Extension and Expansion of PDAB 

In 2021, the Colorado General Assembly passed SB21-175, which established the Prescription Drug Affordability Board (PDAB) “to evaluate and place upper price limits on the highest cost prescription drugs.” Governor Polis touted HB23-1225 as a bill that “will increase the impact of the [PDAB] to save people money on out of pocket prescription drug costs.” HB23-1225 “removes the limit on setting no more than 12 Upper Payment Limits (UPLs) per year in the first three years of the PDAB, and improves the criteria for selecting drugs for an affordability review.” The bill also extends the PDAB’s sunset from 2026 to 2031. CBSA was part of the life sciences coalition that lobbied against SB21-175 and fought for key amendments that mitigated some of the negative impacts of the bill on the availability of life-saving medications in Colorado, HB23-1225 was introduced late last week following the Governor’s press conference; our policy team is evaluating the bill and we expect to take a position on it soon. 

HB23-1201: PBM “Spread Pricing” 

Governor Polis described the PBM “spread pricing” bill by saying that it will save employers money on the healthcare they provide to employees by “holding [PBMs] accountable for lowering prescription drug costs…Currently PBMs can charge employers one price, but reimburse pharmacies less and keep the difference.” HB23-1201, from Representatives Lindsey Daugherty and Matt Soper, prohibits PBMs from charging employers more for a drug than the PBM pays pharmacies for the same drug. The bill also increases “transparency for employers into PBM and carrier behavior that impacts their costs.” CBSA is currently monitoring this bill. 

HB23-1227: PBM Oversight 

Governor Polis said that the “legislature has passed reforms to ensure that PBMs save consumers money, and this bill would ensure that PBMs follow through.” HB23-1227, from Representatives Iman Jodeh and David Ortiz, requires PBMs to register with the Division of Insurance and specifies that the failure of a PBM to comply with current law is an unfair or deceptive act or practice. This would give the Commissioner of Insurance “the power to investigate, hold hearings, issue cease-and-desist orders, and impose penalties on PBMs for failing to comply with consumer protections such as charging pharmacies fees to adjudicate claims, clawing back money from pharmacies inappropriately, and discriminating against independent pharmacies versus PBM affiliated pharmacies.” Since HB23-1227 was introduced late last week, CBSA’s policy team is evaluating it now and we expect to take a position on it soon. 

CBSA’s Advocacy Efforts 

The CBSA Policy + Advocacy team will collaborate with partners and policymakers to advocate for policies that protect patient access to needed therapies and technologies and support a pro-innovation environment for life sciences in Colorado (see CBSA’s Policy Priorities).  

To get involved with CBSA’s advocacy efforts or talk about your concerns, perspective, or position on a bill, please contact CBSA’s Vice President and Counsel for Policy + Advocacy, Amy Goodman

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