In this month’s edition, you’ll find information and insight about upcoming Medicaid redeterminations, coverage of various healthcare-related legislation being considered in Denver, and an update on the work of the Prescription Drug Affordability Board.
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State of Reform
1. Health leaders continue preparation for Medicaid redeterminations
The federal Public Health Emergency’s continuous Medicaid coverage requirement ends on April 1st, and HCPF has announced its plans to start redetermining member eligibility in May with earliest disenrollments occurring in June. The department is working to ensure individuals still eligible for HCPF coverage will be connected to available programs, while those deemed ineligible will be directed to alternative affordable coverage options like the Colorado Option—which saw over 40,000 signups during open enrollment.
Colorado Access, the state’s largest regional accountable entity, experienced a Medicaid enrollment increase of 200,000 during the continuous coverage period. Senior Vice President of Healthcare Systems and Accountable Care Gretchen McGinnis told State of Reform the RAE is working with community partners like the Colorado Coalition for the Homeless and distributing multi-lingual informational videos to members in order to inform them of the upcoming redeterminations. She said it will be important to measure the ROI of their approach to the process and evaluate its effectiveness.
2. Legislature considers bills to restrict PBM practices, improve medication access
In an effort to restrict harmful pharmacy benefit manager practices, lawmakers have introduced HB 1227 to allow the insurance commissioner to take action against violations of PBM requirements and HB 1201 to increase transparency in PBM practices. Gina Moore, PharmD, legislative chair of the Colorado Pharmacists’ Association, told State of Reform that HB 1201 would address the practice of spread pricing by requiring PBMs to charge patients an amount less than or equal to the amount that pharmacies pay for a given drug. Both bills have yet to receive a vote in the House.
To improve patient access to prescription drugs, legislators have also introduced HB 1195 to permit “prescription drug outlets” to establish pharmacy dispensing systems on their premises and HB 1002 to create an epinephrine auto-injector affordability program. Both have passed in the House and await further action in the Senate. [It is] much easier than having to try to find the pharmacy and a health system and get it that way,” Moore said of HB 1002. “So we are excited about the access and that pharmacists are part of that process to help patients get their meds and get them safely.”
3. Prescription Drug Affordability Board considering criteria for selecting drugs
Last month, the Division of Insurance proposed 21 selection criteria to the Prescription Drug Affordability Board for it to use in its determinations of which drugs to apply upper payment limits to. The criteria—which include whether a drug has therapeutic equivalents, the drug’s total utilization by patients, and the drug’s health equity impact—must be approved by the PDAB prior to their meeting scheduled for June 23rd.
DOI will provide the board with a list of drugs that meet initial eligibility criteria for upper payment limits (which is still being reviewed by the board) during their March 31st meeting. Dependent on the board’s approval of DOI’s suggested drugs, the board could select the first drugs for review in June. Per statute, the PDAB is required to enforce UPLs on 12 initial prescription drugs by 2024.
4. Lawmakers take up step therapy reforms
The legislature is considering initiatives that aim to limit the extent of step therapy protocols. HB 1130, a bill that would limit the number of drugs patients must try before accessing a medication to one, passed the House with only three “no” votes on Monday. “Overall, patients that pass through three or more steps incurred total costs of 113% greater than patients with a single-step resolution,” bill sponsor Rep. Michaelson Jenet said, emphasizing step therapy’s negative impact on costs in addition to patient access.
HB 1183 would amend the state’s step therapy protocols by exempting those with serious and complex medical conditions if the provider submits a prior authorization request to HCPF—who would be required to respond within 24 hours. The bill has been amended to address cost-control concerns from HCPF and to articulate that biosimilars can be used in step therapy protocols. It awaits a vote on the House floor.
5. Other health bills we’re watching
Lawmakers are considering legislation to require Medicaid to cover biomarker testing (a method of determining the presence or stage of a disease). HB 1110 passed 10-1 in its House committee of origin and awaits a vote on the House floor. The Colorado Association of Health Plans opposes the effort on the grounds that it would raise premiums.
We’re also keeping tabs on SB 16, which outlines various initiatives aimed at reducing greenhouse gas emissions. Bill sponsor Sen. Chris Hansen said it would “help create a whole lot of forward movement” in Colorado’s path to eliminating greenhouse gas emissions. It updates two similar laws from 2019 by adding GHG reduction targets of 65% for 2035, 80% for 2040, 90% for 2045, and changing the current 2050 goal from 90% to 100%. The legislation has yet to receive a vote in the Senate.