DENVER, CO - The House Health and Insurance Committee today unanimously passed legislation to improve patient access to necessary prescriptions by limiting the number of drug trials needed in step therapy protocol to receive prescription coverage and allowing for pharmacy dispensing machines so Coloradans can access their prescription outside of a pharmacy’s business hours.
“Step therapy, also commonly known as “fail first", requires patients to try treatment options preferred by their insurance company before they can receive coverage and access to medication prescribed by their doctor,” said Rep. Iman Jodeh, D-Aurora, sponsor of HB23-1183. “This process can take weeks or months depending on the medication and can worsen symptoms and quality of life, especially for patients with a life-threatening or chronic disease. This bill puts doctors and patients in the driver's seat, encouraging prioritization of evidence-based solutions to medical issues over cost-effective drugs preferred by insurance companies.”
“This legislation expands step therapy exemptions to include Medicaid recipients so they can access the same quality health care that Coloradans with private insurance have,” said Rep. Emily Sirota, D-Denver, sponsor of HB23-1183. “Last year, we passed legislation to reduce administrative burden, save Coloradans money on unnecessary care, and improve health outcomes. Aligning step therapy protocols will streamline health care, save Coloradans money, and provide quality and immediate patient-focused care.”
In 2022, Representatives Iman Jodeh and Emily Sirota passed a bill limiting when a patient has to try and fail a treatment preferred by their insurance company before they can access the treatment originally recommended by their doctor. HB23-1183 would require the Department of Health Care Policy and Financing to exempt patients with serious or complex medical conditions from the step therapy requirement if the alternative drug would likely cause negative side effects, the alternative drug is unlikely to be effective based on the patient’s history, or if the patient is already using a prescription that has clinical documentation of being effective. The bill passed unanimously by a vote of 10-0.
The bill is accompanied by HB23-1130, which prohibits state-regulated insurance plans from requiring patients to try more than one alternative drug before the insurance company can cover the originally prescribed medication for certain mental health conditions. The bill was recently passed by the House Health and Insurance Committee and will be heard next in the House Appropriations Committee.
“Rural and lower-income communities often live in “pharmacy deserts'' where they have limited access to pharmacies to receive their essential medication,” said Rep. Dafna Michaelson Jenet, D-Commerce City, sponsor of HB23-1195. “Many pharmacies are only open during business hours, making it nearly impossible for working class Coloradans to get their prescription due to their work schedule. This bill would allow for pharmacists to remotely dispense prescriptions from a dispensing machine placed within a health care facility, creating more health care jobs and improving patient accessibility.”
HB23-1195 would allow pharmacies to operate automated prescription dispensing machines so patients could access their medication when the in-person pharmacist is off-duty. The machines would be placed only in a health care facility and would be live monitored to prevent theft. The medication would already be stocked in the machine and patients would be able to discuss the prescription with a live remote pharmacist. The bill passed unanimously by a vote of 11-0.