Coloradans continue to struggle to pay for their prescription medications. The largest yearly survey of Colorado households conducted by the Colorado Health Institute found that one in five Coloradans skipped health-care services due to cost concerns in 2021. Of the almost 10% of Coloradans who didn’t fill a prescription due to cost, 40% said their health declined.

The Colorado legislature has an opportunity to provide immediate relief for patients taking expensive medications. The newly introduced HB 22-1370 begins to address the issue of passing rebate savings to Coloradans, but does it go far enough to truly help those who are most in need of these savings?

Patients who take medications with the highest rebates deserve to benefit the most from them. There are Coloradans of all ages taking expensive medications simply to survive. There’s also those with chronic conditions who have to do so for a lifetime.

HB 22-1370 does not require an insurance company to pass 100% of rebate savings directly to a patient at the pharmacy counter. Unfortunately, the bill allows insurers to control where the rebates can be used and provides no provisions to protect those paying the most for their medications. What’s more, the bill allows insurance companies to enhance their profits when a drug is dispensed, by keeping the financial assistance provided by pharmaceutical manufacturers and forcing patients to pay the full price of the drug. The same is also true of financial assistance raised by family, friends, or charitable foundations to offset a patient’s expenses.

Prescriptions drugs remain unaffordable for patients because patients do not receive the savings for their high-cost medications that insurers negotiate with pharmacy benefit managers (PBMs). PBMs function as a “middleman” between a pharmaceutical manufacturer and the insurance company. PBMs and insurers negotiate significant discounts known as rebates, which they do not share directly with a patient taking the medication. This results in the patient sometimes having to pay more for a medication than the insurance company themselves. The excess cost to patients can be linked directly to insurance companies and PBMs, allowing the corporations to keep the savings instead of passing them along to those patients who need these critical medications.

As drafted, HB 22-1370 dilutes the effectiveness of rebate savings for patients by allowing insurers to use those dollars in a variety of ways. As a result, HB 22-1370 runs the risk of getting lost in the mathematics of rebate savings versus focusing on patients who desperately deserve the relief. A much stronger approach would be to calculate a patient’s out of pocket cost by reducing what they pay at the pharmacy counter with all of whatever rebates are offered by the health plan. In other words, a patient should never pay more for their medication than their health plan.

Coloradans should have immediate access to available rebate savings at the point of sale (whether it’s a physical drug store or mail-order service or specialty pharmacy) so that they have tangible money in hand to use for other necessary expenses. Legislation that would provide cost savings to patients in direct proportion to their out-of-pocket spending on prescription drugs is the simple and fair solution that Coloradans need.

The COVID-19 pandemic has stretched the health-care system and our indefatigable providers in undeniable ways – all while Coloradans with chronic conditions have waited patiently for financial relief to continue to treat their illnesses. Now that the Colorado legislature has an opportunity to pass common sense solutions, will HB 22-1370 be that solution? Not unless it’s redrafted with stronger terms that put patients first.

Kavita V. Nair, Ph.D., is a professor of neurology and pharmacy at the University of Colorado Anschutz Medical Campus and a member of the Center for Pharmaceutical Outcomes Research. She has worked in pharmaceutical-based policies both locally and nationally for over 20 years.