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Committee advances bill letting direct‑to‑consumer drug purchases count toward deductibles
Summary
Senate Bill 26‑167 would allow patients to apply qualifying out‑of‑network direct‑to‑consumer drug purchases toward their insurance deductibles and out‑of‑pocket maximums; the committee adopted a stakeholder amendment adding proof‑of‑payment guardrails and sent the bill to Appropriations unanimously.
The Senate Health and Human Services Committee on Friday advanced Senate Bill 26‑167, a measure intended to reduce out‑of‑pocket prescription drug costs by letting qualifying direct‑to‑consumer (DTC) purchases count toward a patient’s deductible and out‑of‑pocket maximum.
Sponsor testimony emphasized that the bill would not change insurers’ formulary rules or utilization‑management requirements such as prior authorization and step therapy. Instead, the bill would allow consumers to purchase a drug from a manufacturer or DTC platform at a lower cash price and have that expense applied to their deductible and out‑of‑pocket limit, the sponsor said.
Lila Cummings, deputy commissioner for health policy at the Colorado Division of Insurance, said the change addresses a proven affordability gap: she cited the 2025 Colorado Health Access Survey, which found about 12.3% of Coloradans — roughly 707,000 people — did not obtain needed prescription medication because of cost. AARP Colorado and other witnesses testified in support, saying DTC credit could particularly help people with high‑deductible plans.
Senators adopted amendment L1, which requires consumers to submit receipts within 90 days and clarifies acceptable proof of payment; it also restates that insurers’ prior authorization and step therapy rules still apply. Committee sponsors said the amendment addressed concerns raised by insurers and that carriers participated in stakeholder discussions.
After discussion and adoption of the amendment, the committee moved SB 26‑167 as amended to the Committee on Appropriations with a favorable recommendation. The motion carried unanimously in the committee hearing.
The bill will next be considered by the Appropriations Committee.
