Colorado has been making important fixes to health care, passing several critical bills to lower costs and increase access to care – including creating the Colorado Health Care Option and Prescription Drug Affordability Board just last year. However, still, two-thirds of Coloradans are not confident they can pay for their usual health care services and nearly half of the people in our state have put off a medical procedure or treatment because an insurance company denied it, it was too unaffordable, or they could not get services where they lived, according to a recent poll conducted for the Robert Wood Johnson Foundation.
When families cannot afford necessary care or guarantee their insurance coverage will be there when they need it, the consequences can be dire, particularly for those living with chronic conditions who require consistent care just to get by in their day-to-day lives. 62% of adults in Colorado are living with at least one chronic disease and if our state had better access to care, 18,400 lives could be saved annually. That is why Rep. Emily Sirota (D-Denver) and I are sponsoring a bill to make health care coverage more affordable and dependable for Coloradans by requiring transparency when it comes to costs, cutting red tape that stands in the way of better care, and ensuring savings are going directly to lower out-of-pocket costs for patients.
Our bill is essentially a consumer protection bill, making common-sense reforms that will bring integrity and fairness to our health care system and save Coloradans taking expensive medications up to $1,000 a year.
First, this bill will immediately reduce out-of-pocket prescription costs for Coloradans and prevent insurance companies from pocketing the billions of dollars in prescription drug rebates meant to help Colorado patients pay for their medicine. Our bill also bans the surprisingly legal practice of insurance companies pocketing payments made by friends, family, or third-party and charitable entities like GoFundMe meant to offset a patient’s out-of-pocket costs and then still billing the patient for the full cost of their treatment.
Second, our legislation removes medically unnecessary hurdles that patients with complex conditions often have to clear to get the medications recommended by their doctor. Insurance companies sometimes require patients to try and fail a treatment that is not medically recommended before covering medicine recommended by their doctor – a process that can take months known as step therapy. This practice can be dangerous and harmful as it can force patients to take medications their doctor may already believe are risky or ineffective while their condition worsens. As someone with epilepsy, taking the wrong medication can increase my likelihood of having a seizure, putting my safety, and ultimately, my life at risk. Nearly half of U.S. states have enacted common-sense reforms that guarantee patients can get the medicine recommended by their doctors that will keep them healthy, and it is time for Colorado to do the same. In fact, The National Organization of Rare Disorders (NORD) recently graded Colorado an ‘F’ for our lack of step therapy protections. It is time to stop failing patients who need care the most.
Third, our bill ensures contract integrity through consumer protections, so when you sign up for a plan, your insurance company cannot change the terms of medication coverage or cost in the middle of the year. This bill also increases consumers’ ability to plan ahead for expenses and make informed decisions with price transparency through predictable costs like having set dollar amount co-pays.
Nearly 90% of Coloradans believe that health care needs to be affordable for everyone, not just some. We are right to expect that patient health and access to care, not corporate profits, are prioritized in health care. Our bill makes crucial changes so Coloradans can count on and afford the health care needed for all of us to stay healthy.