DENVER, CO - Governor Polis today signed two bipartisan bills that would expand access to community health services through Medicaid reimbursement and save patients and business owners money on prescription drugs.
“As an emergency room nurse, I work hard each session to make life easier for Coloradans seeking affordable, quality medical care,” said Senator Kyle Mullica, D-Thornton. “This year’s efforts will keep more money in the pockets of hardworking families and help Coloradans afford the life-saving medication and care they need. I’m proud to see these critical bipartisan bills signed into law, and I look forward to seeing their impact for years to come.”
“Rural communities like mine often rely on affordable health care services provided by community health workers to receive preventative, primary, and mental health care, but the current funding mechanism makes it more difficult for communities to offer these services,” said Speaker Julie McCluskie, D-Dillon. “This bipartisan legislation Governor Polis signed into law today will allow for Medicaid reimbursement for community health services, connecting Coloradans to necessary affordable health care while also boosting our health care workforce.”
SB23-002, also sponsored by Republican Senator Cleave Simpson and Republican Representative Mary Bradfield, would save money on health care by providing a lower cost option for preventative health care and seeks Medicaid reimbursement for community health workers that would incentivize growth in the workforce. The Department of Health Care Policy and Financing (HCPF) would be authorized to seek federal authorization from the Centers for Medicare and Medicaid Services to provide Medicaid reimbursement for community health worker services, which would secure long-term funding to make urgently-needed care both easier to access and more affordable for the Coloradans who depend on it.
Services provided by community health workers include preventative services, screening, assessments, behavioral or dental health-related services, health coaching, and advocacy. The bill requires HCPF to seek federal approval by July 1, 2024, and to begin implementing coverage once approval is received.
“For every $100 spent at a pharmacy, $82 is evenly split between manufacturer profits and middlemen like Pharmacy Benefit Managers,” said Rep. Lindsey Daugherty, D-Arvada. “Pharmacy Benefit Managers are charging employers one price for prescription drugs while reimbursing pharmacies much less and pocketing the difference. I’m proud that this legislation is becoming law today, so we can save business owners money on the prescription drug coverage they provide to their employees by prohibiting the pharmacy benefits industry from price gouging.”
HB23-1201 is also sponsored by Republican Senator Jim Smallwood and Republican Representative Matt Soper. Currently PBMs can charge employers one price, but reimburse pharmacies less and keep the difference, a practice known as spread pricing. This bill makes it an unfair business practice for PBMs to charge employers more for a drug than what they pay pharmacies for and increase transparency for employers into how PBM and carrier behavior impacts their costs.