Committee backs coverage for coronary calcium screening and narrows patient cost-sharing for cholesterol drugs

Senator Michael Hickey told the committee that the committee substitutes for Senate Bills 278 and 443 would increase access to screening and treatment that supporters said can prevent costly heart attacks.

Hickey described coronary artery calcium screening as a low‑cost CT scan that can detect active atherosclerotic disease and identify people at high risk of heart attack; he said the scan costs about $35 if negotiated and recommended it be treated as a preventive service. "A calcium scan of the heart, a 5 minute procedure that costs about $35 to actually do by the radiologist," Hickey said, explaining the test can detect active disease and lead to preventive care. The committee substitute for SB 278 would reduce or eliminate cost-sharing for the screening and make it easier for primary care clinicians and some pharmacists in expanded roles to recommend and order the test.

Hickey and witnesses also described changes affecting cholesterol treatment in the companion substitute (often discussed alongside the screening bill). Sponsors said the package would remove co‑pays for inexpensive generic statins and address barriers to more expensive second‑line therapies for patients who cannot tolerate statins or do not reach LDL goals. "The other drugs do have co pays, but competition are bringing them down, and they'd only be used if there are side effects of the statins and or if you can't get the LDL below 50," Hickey said.

Supporters included the Office of the Superintendent of Insurance (represented by Vierra Nakeva and pharmacist Alejandro Amparan), the University of New Mexico clinicians, the Coalition of stakeholders and Providence‑area clinical experts. Nakeva told the committee the Superintendent’s office "stand[s] in support of Senate Bill Committee substitute for 75278" (as presented) and recommended coverage in line with clinical guidelines. Pharmacist Alejandro Amparan said heart disease is New Mexico's top killer and stressed the need to reduce barriers to screening and evidence-based medications.

Opponents urging caution included Blue Cross Blue Shield New Mexico and the Pharmaceutical Care Management Association (PCMA). Marla Schoetz (Blue Cross Blue Shield New Mexico) asked for clarity on which cholesterol drugs would be covered without cost-sharing and urged a broader review of the state's multiple single‑drug cost‑sharing changes, noting that eliminating co‑pays shifts costs to premiums and could affect small‑group markets. Jonathan Buxton (PCMA) argued that lowering cost‑sharing would raise premiums because the cost is redistributed across all plan members and urged incentives to favor the most cost effective therapies.

After public testimony and sponsor remarks, the committee voted to advance the committee substitutes. Do‑pass motions for the substitute measures were recorded by the committee. Committee members voting to move the committee substitutes emphasized prevention and long‑term savings; those opposing cited potential premium impacts and urged further study of the cumulative fiscal effect of multiple co‑pay eliminations.

Why it matters: Sponsors argued that modest upfront investments in screening and in removing minor financial barriers to guideline therapies could prevent heart attacks and save substantial future health‑care costs. Insurers warned that without a broader policy review the cost will be shifted into premiums, affecting employers and healthy enrollees.

What’s next: The committee approved the committee substitutes and sent them forward for further consideration; the committee and sponsors signaled a willingness to work with insurers on definitions of covered medicines and on implementation details.