The bill to change how “step therapy” works – or doesn’t – for thousands of Coloradans with chronic conditions and who are prescribed some of the most expensive drugs took another step toward passage Wednesday. 

But House Bill 1370 continues to leave out the biggest driver in the cost of prescription drugs – the pharmaceutical industry, acknowledged Rep. Iman Jodeh, D-Aurora, one of the bill’s sponsors.

Critics of HB 1370 pointed to the pharmaceutical industry as who’s most responsible for drug costs, and the bill’s current version doesn’t ask the industry to reduce them. She said drugs costs are tied to “multiple culprits.”

“We have bills that chip away at the larger issue. Sometimes that happens in individual bills or in sweeping bills,” such as the 2021 Colorado option bill, she said. “This is chipping away at the issue, and helping people with chronic diseases, and for now that’s important. It’s a multi-year process. We’re starting with pharmacy benefit managers and the insurance companies.” 

The bill includes two major provisions. One requires rebates paid to health insurers and pharmacy benefit managers to be passed along to consumers who buy their own health insurance or the employers who pay for those plans in the individual and small business markets. That population makes up about 15% of all insured individuals in Colorado.

Another repeal sets new standards for “step therapy,” under which a patient can be required by a health insurer to take a less expensive drug first before “stepping up” to a more expensive one.

That approach occurs even when a doctor recommends the more expensive drug first, leading to situations in which patients get a cheaper but less effective drug, according to supporters who testified on April 20.

Critics of the measure argue that it would inhibit insurers’ ability to best manage care, while raising the health care costs for everybody.

HB 1370 also would limit the tools health insurance carriers use to manage the price of drugs, affecting the costs Coloradans will pay for health premiums, according to insurers.

The House Health & Insurance Committee, after a week’s delay, approved seven amendments to HB 1370, among them narrowing the definitions of rebates and discounts and not allowing the state’s insurance commissioner to define them; and, clarifying language around timelines for step therapy protocols to align them with existing law. 

HB 1370, which won an 8-2 vote from the committee, moves on to the House Appropriations Committee.

More amendments are likely when the bill gets to the House floor, Jodeh said.