Weekly Policy Blog: PDAB Bill & Biomarker Bill Updates 

CBSA’s Policy + Advocacy team continues to focus on policy priorities critical to our ecosystem in the remaining weeks of the Colorado legislative session. With just over two weeks left, CBSA has taken a position on thirty-six bills, supporting six, opposing two, and monitoring the rest. Some of CBSA’s priorities are moving forward, while others are not. Two noteworthy events from the past week are that: 

  • A favorable amendment was added to HB23-1225, Extend And Modify Prescription Drug Affordability Board, which CBSA still opposes, and  
  • HB23-1110, Health-care Coverage For Biomarker Testing, which CBSA supports, effectively reached the end of its road for this year. 

HB23-1225: Extend and Modify Prescription Drug Affordability Board 

HB23-1225 extends and expands the Prescription Drug Affordability Board (PDAB) established in 2021 (SB21-175) by pushing back the repeal date from 2026 to 2031, expanding the eligibility criteria for affordability reviews, and increasing the twelve-drug limit on upper payment limits (UPLs) that can be set by the PDAB. HB23-1225 originally would have allowed the PDAB to set UPLs on an unlimited number of drugs, but an amendment was added this past week walking back that increase. 

CBSA was very concerned about how HB23-1225 would prematurely expand the PDAB’s authority to conduct affordability reviews for more drugs when they have yet to complete an affordability review and expand the Board’s authority to set UPLs for an unlimited number of drugs when the Board has yet to set a UPL. 

Previously, through CBSA’s intensive member engagement work, collaboration with our partners at PhRMA and BIO, and advocacy with bill sponsors, we were able to negotiate important amendments to HB23-1225, which were adopted in the House on March 20th. That amendment, L.011, secured: 

  • Removal of the “catch-all” eligibility criteria provision that would have allowed essentially any drug to be referred to the PDAB; and 
  • A delay of the implementation of the rest of the changes to the eligibility criteria triggers to January 1, 2025. 

CBSA continued to oppose HB23-1225, but the mitigating amendments we secured in March were an important win. The bill then proceeded through the House and was heard in the Senate Health & Human Services Committee on April 19th, where CBSA again testified in opposition to the bill. At that hearing, Senator Kyle Mullica introduced an amendment, L.019, which modified the provision that expanded the Board’s authority to set UPLs for an unlimited number of drugs: 

  • HB23-1225, as originally introduced in 2023, removed that language excerpted above, allowing the PDAB to establish UPLs for an unlimited number of prescription drugs. 
  • L.019, the amendment added to HB23-1225 on April 19th, modifies that provision in two key ways: (1) It reinstates the 12-UPL limit, but allows the PDAB to set up to 18 UPLs if there is a need to do so and if it has sufficient staff support to do so; and (2) It allows one “prescription drug” to include multiple National Drug Codes that are indicated for the drug. 

HB23-1225, as amended by L.019, passed out of the Senate Health & Human Services Committee on a party-line vote. This new version of the bill is an improvement since it no longer completely eliminates the cap on UPLs the PDAB may set (which applies until April 1, 2025).  

HB23-1225 went on to pass second reading on the Senate floor on April 21st, along with another amendment that reinstated some guardrails around conflicts of interest of PDAB staff and contractors, and then passed third reading in the Senate on April 24th. The bill will now have to go back to the House for concurrence before being sent to the Governor for his signature. 

HB23-1110: Health-Care Coverage for Biomarker Testing 

CBSA supports and has worked to advocate for HB23-1110, which would require insurance coverage for biomarker testing supported by nationally recognized clinical practice guidelines for diagnosis, treatment, and disease management. 

CBSA has engaged closely with the American Cancer Society Cancer Action Network, which is spearheading the effort to pass this bill in Colorado and nationally, testified in the House Health & Insurance Committee on February 21st, and worked with CBSA members to provide additional support for the bill. 

HB23-1110 passed out of the House Health & Insurance Committee on February 21st on a vote of 10-1. Unfortunately, though, the Chair of the House Appropriations Committee informed the bill sponsors on April 17th that the bill cannot move forward without first undergoing the SB22-040 actuarial review process for new insurance mandates over the summer and fall of 2023, so the bill will die on the calendar this year. 

Categories: CBSA News