Help combat high Rx costs harming Coloradan patients | OPINION
As a physician and gastroenterologist, I see firsthand how the high costs of prescription medications prevent my patients from receiving the treatment they need. Too often, I encounter patients forced to make impossible choices — rationing medications, skipping doses, or forgoing treatment altogether — because they simply cannot afford the price of their prescriptions. This is not just a financial burden. It is a medical crisis.
That is why myself and many of my fellow physicians support bipartisan House Bill 1094, which will hold pharmacy benefit managers (PBMs) accountable, create transparency and help lower drug costs for Coloradans.
Though there are many factors in play that make health care unaffordable for Colorado families, PBMs are increasingly inflating the cost of essential medications. PBMs are powerful middlemen that were initially designed to negotiate drug prices and lower costs for consumers. Instead, they have evolved into a system that prioritizes profit over patients. By manipulating formularies, imposing excessive fees on pharmacies and pocketing negotiated savings for themselves rather than passing them on to consumers, PBMs drive up the price of prescription drugs and make lifesaving treatments inaccessible for many families.
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For Coloradans with chronic gastrointestinal conditions, access to medication is not optional. These conditions can cause debilitating pain and serious health complications. When patients cannot afford their prescriptions, they suffer from unnecessary hospitalizations, prolonged flare-ups, and irreversible damage to their bodies. This can have long-term consequences that shape a patient’s health and overall quality of life.
HB-1094 is a necessary step to break this harmful cycle. The bill will increase transparency in drug pricing, ensuring PBMs cannot manipulate the system for their own gain. It will encourage PBMs to use a flat service fee model rather than profiting from high drug costs, prohibit PBMs from favoring expensive brand-name drugs over more affordable generics, and ensure fair reimbursement rates for pharmacies so patients can access medications at their local pharmacy without additional financial barriers.
The Federal Trade Commission (FTC) has launched investigations into the largest PBMs for their role in increasing the costs of insulin, and states across the country are taking action to rein in these middlemen. Colorado must do the same. We cannot continue to allow PBMs to dictate who gets access to life-saving medications and who does not.
As a physician, my priority is my patients’ health. But too often, I am forced to have conversations that are not about the best course of treatment, but about what they can afford. No one should have to choose between paying rent or buying groceries and purchasing the medications they need to function and sometimes even to stay alive. No one should suffer simply because a corporate entity decided to increase profits at the expense of patient care.
House Bill 1094 is about putting patients before profits. It is about ensuring every patient, regardless of their financial situation, has access to the medication they need to thrive. I urge our legislators to support this bill and take a stand for the health of Colorado patients like mine.
Dr. Lisa Mathew is a practicing gastroenterologist at South Denver Gastroenterology in Castle Rock.