The Colorado House Health and Insurance Committee approved two bills on Tuesday that would require health insurance coverage for drugs prescribed for serious mental illness and biomarker testing.
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House Bill 1110, which passed by a vote of 10-1, would require insurers to cover biomarker testing and certain therapies. Biomarkers are an individualized diagnostic method utilized in medicine to indicate the presence or stage of a disease. The FDA approves the development of targeted therapies and drugs based on biomarkers.
The bill’s sponsors contend that these genetic tests and therapies can more accurately diagnose and treat cancer and other diseases, but that high out-of-pocket costs prevent their utilization and lead patients to seek other costly and less efficient diagnostic procedures.
The legislation would ensure Coloradans covered by Medicaid and state-regulated health plans have access to biomarker testing when medically appropriate.
Officials from the Colorado Pharmacists Society, the American Cancer Society, and the Colorado Bioscience Association appeared before the committee to testify on the bill’s behalf, advocating that the policy could help the state achieve better health outcomes, improve quality of life, and reduce costs for its residents.
The Colorado Association of Health Plans (CAHP) testified against the measure saying it would increase healthcare premiums for all Coloradans.
“While carriers are working to determine projected impacts to health insurance premiums, the fiscal note already projects that additional costs to Colorado’s Medicaid program are estimated at approximately $10 million annually,” said associate director of CAHP Brandon Arnold. “We expect that health plans in the small group and individual markets would see similar usage, which would result in a significant increase to the current price of health insurance premiums.
This is a major concern for carriers as they work to lower premiums and especially with respect to the premium reduction requirements of the Colorado Option. Given the importance of the cost of health insurance premiums, we are dismayed that the legislature could have asked for estimates on the cost of this bill directly from the Division of Insurance but did not.”
HB 1130, which passed unanimously, would require health insurance companies to limit the extent of step therapy protocols, which are used when prescribing medication for serious mental illness.
These protocols often require the use of less expensive, and often less effective, courses of drugs than the course initially prescribed. The insurance intervention prohibits providers from prescribing drugs outside of the protocol that could more effectively treat the condition in question.
Rep. Dafna Michaelson Jenet (D – Aurora), sponsor of both bills, said HB 1130 would limit step therapy to one drug for the patient to try before pursuing drugs prescribed by the provider.
Citing the state’s mental health crisis and her own personal struggles with depression, Michaelson Jenet addressed the needs of the bill before the committee.
“Overall, patients that pass through three or more steps incurred total costs of 113% greater than patients with a single-step resolution,” Michaelson Jenet said. “Let me give you a more personal experience about that. I have major depressive disorder. And when I got to the medication cocktail that I am on now, I had to go through a series of drugs before I could take the drug that I am taking today. And the drug that I’m taking today has been an absolute game-changer in my life.
The drugs that I had to take left me suicidal, left me unable to get out of bed, and left me unable to function. I had to go through that process. And as a result, I lost weeks of my life, and I will never get those weeks of my life back. However, now I’m on the medication that my doctor prescribed and it is glorious.”