May 8, 2026 · Health & Human Services · 7,742 words · 19 speakers · 208 segments
Okay, the last, maybe last meeting of the Health and Human Services Committee is, oh my gosh, come to order. Okay, welcome everyone. We are going to be hearing Senate Bill, taking action on Senate Bill 162, Hearing House Bill 1432 and Senate Bill 167 in that order. We have our sponsors here. I will turn it over to Representative Hamrick. Oh, I'm sorry, we should take the roll. It's as if I've never done this before. I apologize.
Mr. Shadoon, could you please take the roll? With pleasure. Representative Barron.
Excuse.
Bradfield.
Representative Bradfield.
Here.
Bradley.
Here.
English.
Excuse.
Goldstein.
Here.
Hamrick.
Johnson
McCormick
Wrighton
Wook
Leader
Madam Chair
Okay, restarting. Sponsors, Representative Hamrick.
Thank you, Madam Chair. I move that Senate Bill 26162 be laid over until May 14th.
Seconded by Representative Wrighton. And Mr. Shudum, please call the roll.
sorry
take your time
representatives is excused
Bradfield
here
what am I doing
we're moving fast
I'm sorry
representative Bradfield
we are
yes
we are all with you
we're voting
to lay over the bill
to May 14th
regret to lay
yes
Bradley
yes English is excused
Goldstein
yes
Hamrick
At the request of the sponsor, yes.
Johnson.
Yes.
McCormick.
Yes.
Wrighton.
Yes.
Stewart.
Yes.
Luke.
Yes.
Leader.
At the request of the sponsor, yes.
Madam Chair.
Yes.
Senate Bill 11-0, two excused. Senate Bill 162 will be laid over to May 14th. Thank you. Thank you, sponsors. Okay, we'll move on to House Bill 1432. We only have a few witnesses today, so we'll do three-minute testimony and ten-minute panels just to make sure everyone knows that. Representative Stewart, do you want to wait for your co-prime?
We can wait.
We can wait, or would you prefer to?
Oh, yeah.
Then the health and human...
Oh, he's here.
Wonderful. We're always asking where Sober is first. Yeah, we're going to make sure it's where Sober. And we're going to put where's Winebook on the back. Who would like to go first? Good morning, Sober.
Good morning.
Take your time.
No problem.
Yeah.
We're voting the same as here.
We are.
.
Thank you. Thank you. Okay, while we're passing out amendments, do we want to go ahead and get started? Who would like to start? Representative Soper.
Thank you, Madam Chair and members of the committee. I will start by saying that we're going to introduce the strike below, and then we have four amendments to the strike below. The strike below seeks to end the hospital transformation program, and the reason why we're pulling that out is from a deal that we negotiated with the first floor yesterday. An email was sent and Colorado has withdrawn from the program. The program began in 2021 in response to the COVID pandemic It is one where it brought down federal dollars matched with state quality programs It was designed for our 43 rural hospitals but in fact the regulatory burden actually cost our hospitals significant money The strike below places back, it's the H-QIP program, and so this is the hospital quality incentives payment program, which generally aligns with national quality framework and existing federal quality structures. It is an incentive program. It is similar in terms to the hospital transformation program. However, this is really the structure and places the framework of the decision-making with the already existing chase board, which is the... And I am blinking out because it's the morning and my coffee is still kicking in, but it's the chase board. And that's basically the bill. So we don't want to be overly prescriptive in statute. Already, I can tell you, just overnight, this bill saved, for example, Delta's hospital over a million dollars. So the cost savings for our rural hospitals are significant with what we're doing here today. This is one that's been carefully negotiated. This was my number five bill, and as you can see, we're down to just a couple of days left before the end of session. So this has been a major, major collaboration between the Colorado Hospital Association, all of our hospitals, the governor's office, and HICPF, and the sponsors. And with that, I'll turn it over to my co-prime.
Representative Stewart.
Thank you, Madam Chair and committee. And a big thank you to my co-prime, Rep Soper, who months ago said he was working on something that would help rural hospitals. And I know it's been a long journey, and he's certainly been leading this conversation for a while. I touched base with some of you yesterday. I don't have a whole lot to follow up with outside of the fact that conversations I've had with CHA and the rural hospitals in my district, having this framework under the Chase Board, which I did look it up because I never remember. It's the Colorado Healthcare Affordability and Sustainability Enterprise. having this set of requirements fall under the chase board is really the right move for hospitals in order to sustain, especially rural hospitals. So I ask for your aye vote today. Thank you.
Any questions for the sponsor? Representative Hamrick.
Thanks, Madam Chair. Thank you so much for bringing this and all your work on it. Can I ask about the performance metric related to workplace violence?
Who would like to? Representative Soper?
Thank you, Madam Chair. Sure. That's, I mean, a great question and one that I'm actually probably going to kick to one of our CHA witnesses.
Representative Bradley.
Thank you. Thank you for bringing this bill. Can you walk me through the hospital quality incentives program and walk me through how overnight we've already saved a million dollars? That sounds awesome.
Representative Soper.
Yeah, thank you. Thank you, Representative Bradley. So the hospital transformation program, as I described, was set up to try to incentivize rural hospitals to have certain quality matrix programs. It's also a redistribution of wealth. The challenge was over the years there became more administrative fees that were taken out of what was being reimbursed back to the hospitals and then there were added more administrative burdens onto hospitals that were almost impossible to meet One, in fact, required hospitals to receive certain data from HICPF by a certain date, but HICPF wasn't getting the data to the hospitals by that date, which meant the hospitals were automatically penalized. And so this was our own state getting in the way of the rules we had created. So it was a program that had good intentions, but over the years, everyone kind of lumped their own goals for hospitals onto it, whether it was trying to reduce payments or have fewer infections. Whatever those goals were, continued to be lumped on. And as different hospitals, for example, had lower patient volumes, like our rural hospitals, they started to be spending more and more on the administrative side, and there was no way they could ever see the reimbursement that came out of the hospital transformation program. And because the program was ended last night, and the strike below is the replacement, that's how all of our hospitals instantly overnight save money. Of course, it will take them a little time to realize that, but it is instant.
Additional questions from the committee? Representative Hamer.
So you talked about the program that set goals for hospitals. Did the hospitals have any voice in the goals that were set? In other words, was there some kind of individuality with the goals based on location or number of patients, or is it just some kind of national goal, or is it like a state goal?
Representative Soper.
Thank you, Madam Chair, and thank you, Representative Hamrick. So a lot of that came out of HICPF, and it was very challenging for our hospitals to meet that because the department wasn't necessarily listening to those who had to implement it. For example, I had an email from Delta's quality person, and she really described the challenges that were taking place and why it was that ideas coming out of Denver were not really helping a place like Delta. And a lot of that came down to not really understanding patient volume, the services that were offered, just challenges of an aging patient population in a rural area. So all those things were compounded. And now placing the framework in the Chase board means that you're going to have hospital executives there. You're going to have people who are in the middle of the medical profession able to lay out this, and it has to be in line with the national acceptance standards. The other element of the strike below I do want to highlight that is really, really important is we lay out that it needs to be practical for the hospital to actually do. And as I said, if you're getting data past a deadline and you have to meet a certain deadline, but the government hasn't delivered you that data, and then you get penalized because you can't produce the report based on the data that comes from the government, that's not practical for the hospital to meet.
Representative Stewart.
Thank you, Madam Chair, and thank you, Representative Hamrick, for the question. I just, in my co-prime, covered it very well. the collaboration between the hospitals, administrators, and HICPF for this hospital quality improvement program These metrics will, you know, the goal is, the shared goal is improving patient outcomes, supporting affordability, reducing unnecessary administrative burden, maximizing the alignment with federal programs, creating more predictable and transparent governance. And through that governance, what we're looking at is, as I said, we're putting that under the chase board, the design decisions for this quality improvement program. and we're going to have clinical and quality experts that have this meaningful involvement and the measures going back will align with national standards wherever possible because when we have those duplicative things or these extra things, the administrative burden becomes greater. So really just trying to bring that into alignment and we have an opportunity under new HICPF leadership to streamline this program and do what's right for all of our hospitals in Colorado.
Representative Hamrick.
So just to make sure I understand this, HICPF sets the goals, yet they miss the deadlines with the data, and then the hospitals are penalized?
Representative Silver.
Thank you, Madam Chair, and thank you, Representative Hamrick. Yes, so under the HTP, that's what did happen. But that now is gone. So I do want to thank HICPF and the new leadership. We have worked incredibly well together to get to where we are now with the replacement for a quality program framework. And I just want to make sure I shout out there that just because some things may get in the way, I mean, we still have a department that has worked very well with us and has been very collaborative here. So that's the problem that we're trying to solve. So that went away as of last night with an email that ended the spa. And then today we're bringing you the strike below, which creates the framework for a quality replacement.
Additional questions from the committee. Representative Johnson.
Thank you, Madam Chair. And so I just want to make sure I'm hearing it correctly, that we're in the prime time for something that our rural hospitals specifically have been seeking because of the step down of the past HICPUF administration that was causing a lot of issues. So we are taking prime time now with the new administrative body of HICPUF that we can actually fix what's been broken. Is that what I'm hearing?
Representative Soper.
Thank you, ma'am. Sure. And thank you, Representative Johnson. Yes, I would generally be in agreement with that statement.
Okay, additional questions from the committee. Okay, seeing none, we will go to witnesses. It looks like we have one witness today, Megan Axelrod. Is she here?
Good morning.
If you can introduce yourself to the organization you represent, and you have three minutes. It's the tiny little button by the plug. Thank you, Madam Chair.
Clearly, I've been busy working on this and haven't been here a lot in this committee this year. So thank you for the reminder. Thank you, Madam Chair and members of the committee. My name is Megan Extraord. I'm the Vice President of Regulatory Policy and Federal Affairs with the Colorado Hospital Association. First I am testifying an amend on House Bill 26 with a huge amount of gratitude to the sponsors Representative Soper and Stewart who have been tremendous leaders throughout this process To the extent that this has been laid out before we were in a terrifying position at the beginning of this year where we were facing a massive wealth transfer amongst hospitals, particularly from rural hospitals to urban hospitals, for care that was provided many years ago. So we were at an extent where there were going to be fines that were levied on the basis of a quality program that didn't necessarily mean, frankly, that there was poor quality being provided to a lot of the flaws identified in HTP before. There were things that people struggled to achieve because it wasn't possible or realistic or reasonable for them to achieve them. We strongly share the goal that all care should be quality care and that that should be fairly and justly graded. And we're incredibly grateful for today's agreement with significant, with which significant collaboration went into from the administration and new HICPF leadership to start a new day of how you define quality programs. As noted before, the shared vision is an HQIP plus program that is co-designed to support the triple aim that improves quality, supports access, and reduces cost of care. Significantly, this will grade hospitals only on things within their control and support governance practices. For example, pediatric hospitals, they have different patients, and so they should be graded differently and not on adult standards. To that end, just an immense amount of gratitude and happy to answer any questions.
Thank you so much. And it looks like we also have Josh Block here, if you'd like to come forward. Introduce yourself to the organization you represent, and you have him.
I've done this before. Hello again, Madam Chair, my name is Josh Block. I'm the Chief Financial Officer of the Department of Health Care, Policy, and Financing. The department is here in support of House Bill 2614-32. This bill, as Representative Soper mentioned, as Megan mentioned, this bill is a product of months of collaboration between the department, the sponsors, the hospital association, and the hospitals themselves. It reflects a shared goal to modernize and improve the way that Medicaid hospital incentive payments are structured so that the program is simpler, more predictable, more focused on outcomes that matter. The existing hospital transformation program was created with good intentions, but it has become too complicated. It has created a complex system of winners and losers, and especially in light of changes that are happening at the federal level, that structure is no longer sustainable. We have an opportunity now to take what we've learned and to build something better. House Bill 1342 allows the department, in partnership with the hospitals and with stakeholders, to create a more streamlined incentive program. The goal is to bring together these existing incentive components into a single, clearer framework that rewards hospitals for activities that reduce cost, improve quality, and improve outcomes for the people that are served by Medicaid. These are practical and common sense goals. When hospitals reduce things like hospital-enquired defections, patients recover faster, they leave the hospital sooner, costs go down across the system. When hospitals improve discharge planning and coordinate with Medicaid managed care entities and regional accountable entities, patients are more likely to receive the medications and the follow-up care and the support that they need as they exit the hospital. This means fewer avoidable readmissions. This means better outcomes. We've heard clearly from hospitals that the program needs to be easier to understand and administer. Measures need to be aligned where possible with other programs. hospitals should know what they are being measured on in advance, and they should be held accountable for actions within their control, not outside factors that they cannot reasonably influence. The department fully supports these goals, and this bill is an important first step to achieve them. It gives statutory authority that's necessary to continue this work with hospitals and stakeholders and to design a program that is transparent, predictable, and focused on improving outcomes improving care while reducing cost We look forward to collaboratively building the next generation of this incentive program in a way that works for our providers and for the people we serve And for those reasons the department supports House Bill 1432 and I'm happy to answer any questions that you have.
Thank you so much. Questions from the committee? Representative Hamrick.
Thank you, Madam Chair. Maybe this hasn't been put into writing yet, but who will be on the Colorado Health Care Affordability and Sustainability Enterprise Board? I know you mentioned practitioners in hospitals.
Ms. Axelrod.
Madam Chair, thank you so much. And Representative Hamrick. So to the extent that the Chase Board already operates, so within the enterprise there is a set statutory definition of who is on the Chase Board and they oversee the activities of the enterprise. What we are incredibly grateful about is that board operates generally very functionally and serves as a great governance entity to the extent that part of the language is very directive that what is taken to the Chase Board board is informed by clinical expertise and then the chase board is able to make that determination. Additional questions, Representative Hamrick. So I asked this question earlier I'm just curious about the hospital quality improvement program must include a performance metric related to workplace violence. Could you explain that? Madam Chair thank you and Representative Hamrick it is a wonderful question so last year there was a piece of very bipartisan negotiated legislation that specifically set out that goal and aim that then moved to a stakeholder process and that worked to implement that measure as in process. Obviously, the hospitals are very supportive of that work continuing and didn't want this effort to unintentionally derail any of the great work that was going on. Additional questions from the committee? Okay. Seeing none,
thank you so much for your participation today. We appreciate it. Are there any other folks that are here in, that would like to provide testimony either in the room or online. Okay. Seeing none, the witness testimony is closed. Okay. Sponsors. We're going to just give one second. I got a list. I know. Okay. Sponsors. Do you have amendments? Right, right. So we've got to plan everything, but I feel like someone else. We've got a plan. Yeah. Representative Stewart.
Go. Thank you, Madam Chair. We do have amendments. Thank you for asking. So I move L-001 to House Bill 1432.
Second.
Representative Hamrick seconds.
Do you want to talk about this, or should we move the other one? We'll move the other ones. Let's just do that.
I move L002 to L001.
Second.
Seconded by Representative Fryden.
Representative Stewart.
So I just moved L002 to L001.
And if Rep. Sober would like to talk about L002.
Representative Sober. Thank you, Madam Chair. So Amendment L002 is really a cleanup amendment. So we had improvement program. We're changing it to incentive program. And then down in the middle of the amendment, we're making it clear that it can go up to 9% after Chase Board approval. So the reimbursements could go up to that amount.
Okay great Any questions on this amendment Representative Bradley Thank you Madam Chair So what was the reason for changing from improvement to incentive
Representative Soper.
Thank you, Madam Chair. Thank you, Representative Bradley. That's a great question. We had laid out improvement and incentives in different parts of the strike below. And we kind of used them interchangeably. So we decided late last night that incentives would be better to use all throughout the bill rather than improvement. Because it is an incentive program, and we're trying to incentivize hospitals. I mean, we are trying to improve them too. So I suppose we could have picked one or the other. We just happened to have picked incentives. OK.
Any additional questions? Any objections to L002? Seeing none, L002 passes. Okay.
Representative Stewart. Thank you, Madam Chair. I move L003 to L001.
Second.
Second by Representative Wright.
Johnson. I don't know who it was.
Representative Johnson?
Okay. Would you like to describe the amendment?
Representative Soper. Thank you, Madam Chair. So, Amendment 3, 4, and 5 are really, really technical amendments. So the change that takes place is really at the top for the reference points in statute, and then just saying a hospital quality incentive program at the bottom. We just had to have everything in the middle for reference purposes.
Any questions on this amendment? Any objections to this amendment? Okay, with that, L003 passes.
Representative Stewart. Thank you, Madam Chair. I move L004 to L001.
Second.
Second, Representative Johnson.
Would you like to describe L004?
Representative Sober. Thank you, Madam Chair. L004 is also purely technical. We had restated what's being crossed out. So this looks a little out of context, but it's not that anything really changed here.
Okay. Any questions on this amendment? Any objections to this amendment? Okay, seeing none, L004 passes.
Representative Stewart. Thank you, Madam Chair. I move L005 to L001.
Second.
Second by Representative Johnson.
Would you like to describe the amendment? Representative Sober. Thank you, Madam Chair. So this amendment, just like all the others, we just added the one line at the bottom, so it's just a reference amendment.
Okay, any questions on this amendment? Any objections to this amendment? Okay, seeing none, L005 passes. Okay, Representative Stewart.
Thank you, Madam Chair. So I've already moved L001, which is the strike below, which is the bill that we've been speaking to and happy to let Representative Soper bring us home.
Representative Soper. Thank you, Madam Chair. Well, L001, as amended, is the bill, since it's a strike below, and it does everything that we've described. So it's the replacement program. So HQIP will be the replacement program for HCP.
Any questions on L001? Any objections to L001? Okay. Seeing none, L001 as amended passes. Okay. Do you have any additional amendments? Okay. Any amendments from the committee? Okay. Seeing none, the amendment phase is closed. Would you like to move your bill and wrap up?
It's going to...
The committee of the whole.
Yes, thank you, Madam Chair. I move House Bill 1432 as amended with a favorable recommendation to the committee of the whole.
Second.
Second by Representative Johnson.
Would you like to wrap up?
Yeah, thank you, Madam Chair. Good bill vote yes.
Representative Sofer. Thank you, Madam Chair, and thank you, members. Thank you to my co-prime sponsor as well for going down this wild ride. I know much of it was never seen by most people. But I will say this is one of those bills that you can actually say we did something incredibly good for not just our rural hospitals, even our bigger hospitals. But this has direct savings that immediately took place today, and all of our rural hospitals are in full support. Wonderful. Thank you so much for your comments.
Any comments from the committee? Okay, seeing none, Mr. Student, could you please call the roll? Representative Barron is excused. Bradfield? Yes. Bradley? Yes. English is excused. Goldstein? Yes. Amrick? Yes. Johnson? Yes. Cormac? Yes. Bryden? Yes. Stewart? Yes. Wook? Yes. Leader? Yes. Madam Chair? Yes. passes 11 to 0. To excuse, you're on your way to the Committee of the Whole. Thank you so much. Okay, the Health and Human Services Committee will go into a brief recess while we locate our sponsors. Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Thank you Thank you. Thank you. Human Services Committee will come back to order. Welcome sponsors. We are ready whenever you are, but take your time. Sure. Oh, okay. Dusty will take one. When Bay Snacker's ready. Okay. Mine first. Okay. Turn this way. Nice, nice, and nice. Okay. Speaker pro tem Basenecker.
Thank you, Madam Chair. Thank you, Committee. Thanks for your patience with us this morning, but I think we're still going to get out of here before judiciary. So, second place is first runner up. We're pleased to present Senate Bill 26-167 before you today. The bill is really pretty straightforward and simple. It's just about ensuring that Coloradans can lower their out-of-pocket costs for their needed prescription drugs. I think we all know that folks in our communities are struggling to afford the cost of healthcare and specifically the cost of their prescription drugs. A poll from 2025 found that more than one in four adults report difficulty in affording their medication. There's a growing trend in the pharmaceutical industry to offer lower prices using direct-to-consumer platforms like the new TrumpRx, GoodRx, or Cost Plus Drugs. And these platforms offer large discounts on common and popular medications. But these prices are typically only available for patients to use outside of insurance.
This bill allows consumers with insurance to also benefit from those same direct discounts. This is about giving consumers options. If a drug is cheaper for a person to access through their insurance plan, that's great. But if a direct-to-consumer platform offers the same drug at a larger discount, the person should have the option to purchase the drug at the cheaper price and then have it count towards their out-of-pocket maximum or deductible. While the bill offers new options to keep drugs affordable for consumers, it also provides important protections for insurance carriers, and this is the amendment that was run in the Senate. These platforms may not solve drug affordability crisis we are facing, but they are a tool that keeps consumers in the place where they're able to use these tools to help them manage their out-of-pocket expenses. And with that, I'll turn it over to my co-prime. Representative Lindsay.
Thank you, Madam Chair. Thank you, Committee. As my co-prime mentioned, consumers with insurance should be able to...
Yeah, hold on. Give me two seconds. That was weird. For the record, Representative Barone has joined us. Representative Lindsay. Thank you, Madam Chair.
I just get so choked up about the importance of this bill. Oh, consumers with insurance should be able to benefit from cheaper prices that are now available from drug manufacturers. This bill will not change or alter the basics of a person's health insurance plan. If a drug is not currently covered under their plan, they will not be able to purchase direct to consumer and get credit. Additionally, utilization management processes will also still apply, meaning a consumer must still follow step therapy. and prior authorizations in order to get credit. This policy is not a workaround insurance requirements, but it means to give consumers more affordable options for purchasing their drugs. This bill could be helpful for a person with a high deductible plan who typically must pay the full cost of their prescription in the first two months to hit their deductible. With this proposal, the person could spread the cost out by being able to purchase the drug for a cheaper price on a direct-to-consumer platform. some examples a drug used to treat type 2 diabetes sold by the drug manufacturer astrazeneca is available direct to consumer for a price at 70 percent lower than the wholesale acquisition cost a commonly prescribed blood thinner drug has a wholesale acquisition cost of 600 but is available at the direct-to-consumer price of $346,000 that represents a 43% discount. The sponsors in the Senate worked with stakeholders and adopted an amendment to address concerns raised by the insurance carriers. So the bill is in great shape, and we urge your support of this bill. Thank you.
Thank you, sponsors. Questions from the committee? Vice Chair Leader.
I just want to make sure I understand it correctly. So any deductible that I have on prescription medicine will go apply towards my I mean any cost out cost would apply towards my deductible
Speaker Pro Tembe, Senator.
Thank you, Representative Leader. Thank you, Madam Chair. So the way the bill is set up, there's a couple of key provisions that I think merit paying attention to. First off, if for some reason the out-of-pocket cost of buying direct is actually higher than the price of what your insurance company would provide that same medication for, that medication you would not be eligible for reimbursement because ultimately you'd be charging your insurance plan for more than they could otherwise acquire that same prescription drug for. The second piece is this. The process is listed out on page three where it says you have to purchase a prescription drug and then also direct pharmacy or direct consumer platform for the prescription drug. So that's sort of step one in the eligibility. But past that, there's also the need to comply with provisions such as prior authorizations or if your insurance carrier or that particular medication has a step therapy protocol attached with it, you would also need to comply with those things. Barring any of some of those extenuating circumstances, yes, largely if you purchased a drug, let's say through GoodRx, and that drug is available for cheaper than it would be through your insurance plan, you would be able to submit a receipt within 90 days of that purchase. So long as you made that purchase in your current plan year, that deductible, that price of that drug could apply to your deductible or out-of-pocket maximum for prescription medication.
Additional questions from the committee. Representative Bradley.
Thank you. I get it. Do we need a bill? Are insurance carriers not allowing this to happen? Are they not reimbursing? I have used GoodRx many times when you have a high deductible prescription plan. So they're not allowing people to then apply that to their deductible right now, and that's why we are having to put this in statute? Is that what's happening here?
Speaker pro tem base, Nicker.
Thank you, Madam Chair. Thank you, Rep. Bradley. I think we have a witness from Division of Insurance who can talk about, or maybe someone available for questions only, who can talk about sort of like current practice. But my understanding would be, I think generally that insurance carriers would not be obligated to go through this process were absent the legislation. That being said, I think the requests that our insurance carriers made in this first chamber make a lot of sense just to ensure that ultimately the process is one you can comply with. I think there's probably a gap for folks that don't have like an HSA or something like that, because that's how we do it. You know, like I take out an HSA every year and then I get those expenses reimbursed. But if you don't have that option, I think this would be another option to make sure that these things apply to your out-of-pocket maximum or deductible, and you're not just simply getting reimbursed for that cost.
Representative Johnson.
Thank you, Madam Chair. Thank you, sponsors. Can you just explain the cost analysis of how RX is able to provide these medications cheaper, and how do they offset that to still stay in business versus if insurance has to take this on? Where are they going to offset that?
Speaker Pro Temp-Basenacker?
Thank you, Madam Chair. Thank you, Representative Johnson. So I can't speak to good Rx's or Trump Rx or any other pricing models, like how they set those things. It is important to note, however, there is no additional cost for the insurance company, right? It is simply just making sure that it can apply to your deductible. So it's not as if the insurance company has to match that price. They're simply applying that same cost to your out-of-pocket maximum or deductible. so the pricing models I mean you know there's a lot of I think consternation generally in the public about how prescriptions are priced I share that too this is just one way that we can say okay that being what it is right and without a hard price cap or control on some of those things this is one way that we can offer savings to consumers if you know you can get that drug cheaper someplace else
Additional questions from the committee? Okay, seeing none. Oh, I'm sorry, Representative Hamrick.
Thanks, Madam Chair. Thank you, Sponsor, for bringing the bill. Do other states do this?
Speaker, Proton Basenacker.
Thank you, Rep Gilchrist. Thank you, Rep Hamrick. I don't know. That's a great question. I can find out for you. Yeah. We could be a leader, which is really exciting. Yeah, right.
Okay. Additional questions from the committee. Okay, seeing none, we'll move on to the witness phase. Looks like we have two witnesses today, Jill Mullen and Rebecca Gillette. One of those should – oh, perfect. Hi there. You can go ahead and introduce yourself of the organization you represent, and you have three minutes. You're already on, so you're all good.
Good morning, committee. Thank you for the opportunity to testify today. My name is Jill Mullen, and I am a policy advisor at the Division of Insurance. I am here today in strong support of SB 26167. First, I would like to express my appreciation to the sponsors for bringing this bill forth and really working with the division and stakeholders to bring forth the policy that's in front of you today. The point of this bill is very simple. We want to save people money on their prescription drugs. I think we all know people who have struggled to pay the costs of their medicine, even if they have insurance. Recent data from the 2025 Colorado Health Access bears this out. This survey found in 2025 that 12% of Coloradans didn't get needed prescription medicine in the last year due to cost. This equates to about 700,000 people. Of those who said they were impacted by prescription drug costs, 66% of people with commercial insurance said they didn't get prescription medicine because the cost of the copay was too high. So as the sponsors mentioned, the bill does not change any terms of a person's health benefit plan. Consumers still need to comply with any formulary requirements applicable to their drugs. but it does give consumers a choice, a choice to purchase a drug through a direct-to-consumer platform at a cheaper price than is available with their insurance. It's only fair that insurers should count those costs towards the consumer's deductible and out-of-pocket max. Thank you for the opportunity to testify today, and I'm happy to answer any questions. Thank you so much. We'll
move to online. If you can introduce yourself, the organization you represent, and you have three
minutes. Thank you. Good morning. Thank you, Madam Chair, committee members, and the bill sponsors. My name is Rebecca Gillette, and I am here on behalf of the Chronic Care Collaborative, a coalition of nonprofits that advocate for the two-thirds of Coloradans living with chronic conditions and their caregivers. We're here to express our support of SB 26-167. Our work is guided exclusively by the lived experiences of our patient and caregiver community. When you live with a chronic disease, you're on the front lines of understanding the high cost of prescription drugs needed to help you survive and thrive. The affordability of our health care is vital. And right now, we're only talking about the medications that people need and have no time to discuss the affordability of insurance itself to even access the care that patients need. But the amount already required for patients to pay for health care access alone can be a hardship for many. The CCC supports this bill because it provides patients with the ability to price shop to get their prescriptions filled at any licensed pharmacy that offers them the lowest price, while making sure whatever the consumer pays out of pocket goes toward their deductibles and out maximums Patients don get to decide which drugs are on their insurance carrier formulary They should get to decide where they fill their prescriptions to save them the most amount of money possible. They're paying plenty out-of-pocket and plenty of money to survive as it is and manage their chronic conditions, so the freedom to choose how they can save their money should be a no-brainer. It should be a priority to determine how we can increase access and lower costs for patients who need it the most, because in all reality, they are paying the most. People living with chronic disease know a major part of their annual budget goes toward their care, and it's more than just insurance, premiums, and medication payments. There's other out-of-pocket expenses that sometimes they can't access because of the cost of insurance and medications. So significant out-of-pocket costs can deter them from accessing medical equipment they might need, the ability to pay to access other therapies like mental health, physical or occupational therapy, or even access to healthy foods. So many things the patient may want or need to access could be cost prohibitive. So if they can't afford it, they might not be able to access those things. But if we can save them money out of pocket on medications, that might make a difference. The CCC will always advocate for putting patients first, especially the most vulnerable. And we urge your yes vote to support this bill to provide savings to the patients who need the medications to begin with. Happy to answer any questions for the committee or provide an example of how this could have benefited patients if this bill were in place prior to now. Thank you so much for the time. And again, if you would like me to share an example, happy to do that.
Thank you so much for your testimony. Questions from the committee. Representative Johnson.
Thank you. And I'm just trying to figure out kind of what I asked the sponsors. And this is to any of the panelists, both of you. if this is going to go to deductibles, are we going to see private insurance then raise those deductibles to match what this is going to do when they have to accept it?
Ms. Mullen?
Thank you, Madam Chair. Thank you for the question. So under the bill, you would only be able to purchase a drug direct to consumer if it's cheaper than what's currently available on your plan. plan. Most folks that are purchasing prescription drugs, let's say you have a really high cost prescription drug and you purchase it through your plan and it's $500, you know, your deductible is a thousand, you hit your deductible in the first two months, and then it's covered for the rest of the year. Under a direct to consumer platform, you might be able to purchase that drug for $200 or $300. And then you can kind of spread out that cost. So you wouldn't actually hit your deductible until maybe the fourth or the fifth month of the year. So it kind of allows consumers a little bit more flexibility to manage their prescription drug expenses. Does that answer your question?
Representative Johnson. Thank you, Madam Chair. Not really, and I'd love to talk more, because I'm sure that the insurances have it in their formula of why they're able to offer something due to their works with PBMs and other things. So I'm just curious how this is going to affect the overall formula, that yes, they're not getting it here, but now it's going to affect the deductible over here. And there's a lot more things. I would just love to talk on the formula side.
Sorry, are you asking the question or do you want to talk?
More clarification of it didn't make sense, but would love to talk offline because we're messing with what they've already set in place for cost analysis, especially in the private sector. So just really curious on, yes, I see what you're saying, but they've said it for a reason with their negotiations on why they have this. And I just want to know the whole thing, so...
Ms. Mullen, would you like to respond?
Sure. Yeah, Madam Chair, I can take a stab at that and then we can have longer conversations. I think that the, you know, I can't speak to how a current carrier sort of structures their formulary or what their current costs are for a prescription drug, but I do think that this may incentivize carriers to negotiate a better rate for some of these prescription drugs because they are available direct-to-consumer at such a low price. And I don't actually, like, right, not knowing necessarily what that nexus is of how much an insurer is currently paying for it, but, like, with these lower prices being available, let's bring down that cost. And so to the extent that maybe PBMs might negotiate to a cost that's maybe closer to a direct-to-consumer price, that seems like an incentive for consumers.
Representative Bradley. Thank you. I'm just trying to figure out, do we need state statute for this? Because I have done GoodRx multiple times because my prescription benefits were so high or deductibles so high. Are there claims that are being denied? And if there are claims being denied, if somebody uses GoodRx for a $2,000 prescription benefit plan, if let say Cigna says no we going to deny that because you didn go and pay for this medicine I need evidence that claims are being denied in Colorado before we pass another bill to mandate this So do you have statistical analysis showing us that claims are actually being denied versus me just filing it with my insurance carrier to add to my prescription
plan deductible? Ms. Vaughn? Thank you, Madam Chair, and thank you for the question.
yes, currently direct-to-consumer purchases are considered out-of-network and would not be reimbursed by your – or not be credited towards your deductible by your insurance plan. And this is essentially making that change considering that direct-to-consumer platforms are becoming more popular and this is becoming a way that people are getting their drugs. So let's take that innovation and apply it to insurance.
Additional questions from the committee? Okay, seeing none, thank you all so much for your testimony today. Okay, is there anybody else in the room or online that would like to testify today? Seeing none, the witness phase is closed. Sponsors. Representative Lindsay.
Thank you, Madam Chair. Thank you, Committee. I'm going to be quick and say a good bill vote yes.
Oh, sorry. I should have asked, do you have any amendments?
As unamended.
Unamended Okay Any amendments from the committee Okay Seeing none the amendment phase is closed Sorry about that Representative Lindsay Good bill vote yes
Speaker Proton Basenecker. Thank you, Madam Chair. Thank you, committee. I appreciate your time this morning. I think this is really just a cost savings measure for consumers. Representative Johnson, I'm happy to also talk with you offline about how I think actually the situation you're identifying would have actually the inverse effect, to where now you have an insurance company that's actually able to charge less for a drug, reimburse less for a drug towards the out-of-pocket maximum or deductible than they otherwise would. I think actually that's favorable for both parties, right? Because you have a drug that's cheaper on the consumer side, and on the insurance side it's less of a charge for them that they have to reimburse through the deductible or they have to count towards the deductible. And so I think it favors both parties as opposed to incentivizing some sort of increase in deductible. And so I think happy to talk more about that, but I have a very different understanding. I think we can clear it up pretty quickly. So with that, committee, appreciate your time.
Asking for a yes vote. We already went through that. Vice Chair Leader, would you like to move the bill?
I move Senate Bill 26167 to the committee of the whole with a favorable recommendation.
Second.
Representative Hamrick seconds.
Any closing comments from the committee? I just want to thank you for bringing the bill It a good bill Whenever I hear somebody mention about someone not getting medication because of the fact that they couldn afford it it brings me back to a childhood friend that, I think he was in his 30s and he couldn't afford his blood pressure medicine and literally died from it because he refused to ask his parents for any money to help him pay for it. He passed away from it. So I'm all for anything that's going to save money on this front. So thank you.
Representative Bradley. Thank you. And thank you to the bill's sponsors. Here we are, right, late in session, and this comes quickly. And so I'd appreciate the conversation offline to get into a better position of what this bill does and what you had just said. So we'd love that off-record conversation.
Thank you. Okay. Seeing no additional comments from the committee, Mr. Stardew, please call the roll.
Representative Zardew. No. Redfield. no Bradley no English yes Holstein yes Hamrick yes Johnson no McCormick yes Wrighton yes Stewart yes Wook no Peter yes
Madam Chair yes passes 8 to 5 you're on your way to the committee of the whole thank you sponsors and with that the Health and Human Services Committee is adjourned Colleen!