By Victoria Vicory

Managing a chronic health condition isn’t easy. For hundreds of thousands of Coloradans, it means daily medication, careful monitoring, regular appointments, and constant worry about how to afford it all. For too long, the high cost of prescription drugs has forced patients into impossible choices: skip a dose, cut pills in half, or go without them entirely. That’s why the passage of House Bill 1094 to reform Pharmacy Benefit Managers (PBMs), sponsored by my own state Rep. Kyle Brown, is such a monumental win for patients.

HB-1094 brings long-overdue accountability to pharmacy benefit managers (PBMs), the powerful middlemen who manage drug benefits for insurers. Though few people know what PBMs are or how they function, they affect nearly every prescription filled in the United States. Today, three powerful PBMs control 80% of the market and profit most when drug prices go up, not down. They decide which medications are covered, how much pharmacies are paid, and how much patients must pay out-of-pocket with little to no transparency or accountability. 

PBMs make it their business to decide what is medically necessary, disempowering patients and their physicians from being able to determine the best treatment options. This is particularly difficult for patients like myself with hemophilia, who don’t have an option for generic medications. For us, the loss of treatment means disability or even death in many cases. 

Though PBMs were originally intended to negotiate lower drug costs for patients, over time PBMs have quietly distorted the purpose they were created for. Instead of lowering costs, investigations show they routinely steer patients toward higher-priced drugs in order to benefit their own bottom line and pocket rebates intended for patients.

The consequences for patients are devastating. Coloradans across our state are delaying necessary medications because they can’t afford the out-of-pocket costs. Many are all but forced to watch their conditions worsen as they attempt to navigate this opaque system and battle to get the care they need and deserve. This takes precious time, energy, and resources away from caring for health and actually doing the work of managing their conditions and their lives.

HB-1094 offers real reform. By requiring PBMs to be paid a flat, transparent service fee instead of profiting off the cost of the medication, it ends the perverse incentive to push higher-cost drugs. This brings desperately needed transparency to a system that thrives on complexity and confusion.

The Federal Trade Commission is currently investigating the top PBMs for manipulating prices and harming consumers. A 2024 report by the Office of the Assistant Secretary for Planning and Evaluation found PBMs have the highest profit margins in the entire pharmaceutical supply chain — more than $60 billion last year. And a recent FTC report showed these PBMs imposed markups of hundreds or even thousands of percent on essential generic drugs.

With HB-1094, Colorado becomes a national leader in addressing these abuses. The bill creates a competitive marketplace where PBMs can still earn a profit, but only when they deliver savings and value for patients, not just shareholders.

Rep. Brown deserves enormous credit for taking on this challenge. He listened to patients and physicians. He collaborated across the aisle. And he kept the focus where it belongs: on people who rely on medications to live full, healthy lives.

There is still much to do to make our health care system fairer and more affordable. But HB-1094 is a major step forward. It sends a message Colorado will no longer accept a status quo where middlemen profit while patients suffer. Thanks to the leadership of lawmakers like my own Rep. Brown, as well as Rep. Dusty Johnson, Sen. Dylan Roberts and Sen. Byron Pelton, we are one step closer to a health care system that puts people first.

Victoria is a patient with mild hemophilia A and has two adult children with severe hemophilia. She has been advocating for health care reform as a constituent, caregiver and patient since 2010, focusing her efforts on the unique needs of those with genetic bleeding disorders and on improving the quality of life for all that are affected by chronic disease.