Governor Polis, State Legislators Announce Plans to Help Save Coloradans Money on Health Care

Thursday, March 2, 2023


Legislative package will cut prescription drug costs, reduce premiums, strengthen the health care workforce and decrease hospital costs


DENVER - Today, Governor Polis and Lt. Governor Dianne Primavera partnered with state lawmakers and community members to announce a legislative package to save people money on health care and increase transparency within the healthcare system. 


“Coloradans are sick and tired of paying too much for health care. The cost of health care is out of control, and we need to build on previous work and take new actions to reduce costs and save people money,” said Governor Polis. “Saving people money on health care has been a priority of my administration over the past four years, and I am grateful for the bipartisan partnership from the state legislature as we continue to take strong action.”


The plan builds on previous shared efforts of the Polis-Primavera administration and the state legislature to save people money on health care through the Reinsurance Program, Colorado Option and the Prescription Drug Affordability Board.


“As director of The Office of Saving People Money on Health Care and someone who understands the impact costly medical bills can have on a family, it’s vital we continue to promote healthcare savings here in Colorado. I am proud of the work we’ve accomplished  so far, but there is much more we can do,” said Lt. Governor Dianne Primavera. “I am grateful for the partnerships and dedication of care providers, advocates, hospitals, patients, and our Colorado legislators to ensure we are continuing to promote health and wellbeing statewide.” 


“From creating the Colorado Option, which is lowering premiums and out of pocket costs, to ensuring drug pharmacy benefit managers pass on manufacturer rebates to consumers, we’ve made critical progress saving Coloradans money on health care,” said Representative Iman Jodeh, D-Aurora. “The legislation we’re introducing today will lower premiums for Colorado Option plans and hold the pharmacy benefits industry accountable to protect consumers and employers and reduce the cost of prescription drugs. These bills will make access to affordable care more equitable for Coloradans who have disproportionately faced barriers to the services and treatments they need.”


“Every Coloradan deserves to have access to the lifesaving health care they need, but in the communities I represent on the Western Slope, quality and affordable health care can too often be too hard or even impossible to come by,” said Sen. Dylan Roberts, D-Avon. “We’ve made real progress over the last few years to lower health care costs, but there is always more we can do to get families the care they need. These bills will build on our success by making it easier for Coloradans to shop for plans and lowering premiums, increasing transparency, and improving access to prescription drugs so that more families can access the care they need to thrive.”


“This plan delivers on our promise to make Colorado more affordable by saving people money on health care and reducing the cost of prescription drugs,” said House Health and Insurance Committee Chair Lindsey Daugherty, D-Arvada. “By increasing transparency and holding large corporations and profitable industries accountable, we will address the systemic issues that are driving up the cost of health care.”


"As a pharmacist, I am thrilled to be part of the team working on such historic and breakthrough health care policies,” said Sen. Sonya Jaquez Lewis, D-Longmont. “Whether it’s lowering the cost of prescription medications, improving access to mental therapy, or helping patients understand their medical procedures so they can make a plan to pay for them, all of these proposals are a crucial part of our Colorado health care legislation this year."


These highlighted efforts will increase transparency, save employers money on prescription drugs, and increase hospital accountability to invest in community health needs. The legislation will ensure premiums decrease for Colorado Option plans and increase the effectiveness of the PDAB to lower out of pocket prescription drug costs for Coloradans. 


Reducing Premiums for Colorado Option Plans; Representatives Iman Jodeh and Kyle Brown and Senator Roberts. 


This bill will lower insurance premiums and make it easier for consumers to shop for high value plans that work for them and their families. It strengthens the Division of Insurance’s (DOI) ability to hold carriers accountable for the premium rate reduction requirements on Standardized Plans by allowing the DOI to:

  • limit factors such as as excessive profit and administrative expenses; 
  • structure the public hearings process efficiently while ensuring all parties the opportunity to participate; 
  • help consumers easily find and compare plans that could lower their out-of-pocket costs.


Expanding Prescription Drug Cost Saving Measures; Representatives Chris deGruy Kennedy and Dickson and Senator Sonya Jaquez Lewis 


In 2021, lawmakers passed the Prescription Drug Affordability Board to evaluate and place upper price limits on the highest cost prescription drugs. The legislation unveiled today will increase the impact of the Prescription Drug Affordability Board to save people money on out of pocket prescription drug costs. It 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. 


Saving Employers Money on Prescription Drug Coverage; HB23-1201, Representatives Lindsey Daugherty and Matt Soper 


By holding Pharmacy Benefit Managers (PBMs) accountable for lowering prescription drug costs, this legislation will save employers money on the health care they provide to employees. Currently PBMs can charge employers one price, but reimburse pharmacies less and keep the difference. This bill makes it an unfair business practice for PBMs to charge employers more for a drug than what they pay pharmacies for the same drug and increase transparency for employers into PBM and carrier behavior that impacts their costs. 


Holding PBMs Accountable; Representatives Jodeh and David Ortiz


The legislature has passed reforms to ensure that PBMs save consumers money, and this bill would ensure that PBMs follow through. This bill will provide the Division of Insurance with more direct oversight over PBMs by requiring them to register and specifying that the failure of a PBM to comply with current law is an unfair or a deceptive act or practice. This would allow the commissioner 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.


Ensuring Large Hospitals Invest in Our Communities to Lower Health Care Costs: Representative Judy Amabile


When nonprofit hospitals make billions more than they spend each year, that money should be invested back into our communities. It should go toward projects that save people money on health care and increase access to quality health services. This bill ensures that communities have more of a say in how hospitals invest their surplus revenues. It will require a minimum level of community investments for these high-revenue hospitals to retain their nonprofit status. It would also bolster transparency and reporting on community benefit investments by hospitals. 


Improving Hospital Transparency; Representatives Kennedy and Matt Soper


This legislation sheds light on the underlying drivers of high hospital costs by building on existing hospital financial transparency reporting to address gaps, increase compliance, and provide data to understand the financial health and performance of Colorado’s hospitals.


Increasing Consumer Protections Medical Transactions; SB23-093, Senators Lisa Cutter and Sonya Jaquez Lewis and Representative Weissman


The bill strengthens consumer protections related to medical debt and out-of -network billing by making failure to comply with the following provisions deceptive trade practices. The bill: 

  • requires debt collectors to provide itemized statements to consumers within 30 days of a request that include whether the patient was screened for financial assistance; 
  • prohibits collection of debt, reporting of unpaid charges to a credit reporting agency, selling of medical debt, or initiation of civil action/arbitration while the consumer is engaged in an appeals process with their payer;
  • places a 3% cap on the interest rate on medical debt; and
  • establishes transparency and consumer protection requirements surrounding payment plans; extends consumer protections during legal action on a medical debt. 


Boosting Employment Of School Mental Health Professionals; SB23-004, Senators Marchman and Jaquez Lewis and Representatives Mary Young and Dafna Michaelson Jenet


This bill makes it easier for health professionals to work in schools if they hold a Colorado license, without having to go through a burdensome Department of Education Process. This bill saves money on health care by helping more students access mental health services in schools and will ensure our students are getting the care they need. 


Increasing Access to Community Health Services; SB23-002, Senators Kyle Mullica and Cleave Simpson, Speaker McCluskie and Representative Mary Bradfield 


This bill authorizes HCPF to seek CMS authorization for Medicaid reimbursement for community health workers. This bill saves money on health care by providing a lower cost option for preventative health care and brings in reimbursement rates for community health workers that will incentivize growth in the workforce.