Committee backs bill letting certain direct-to-consumer drug purchases count toward patients' deductibles

The House Health and Human Services Committee on May 12 voted 8–5 to forward Senate Bill 26-167 to the Committee of the Whole with a favorable recommendation. Sponsors said the measure allows insured consumers to purchase covered prescription drugs through direct-to-consumer platforms and submit the receipt so the out-of-pocket payment counts toward their plan deductible or out-of-pocket maximum for prescription drugs.

Speaker pro tem Basenacker told the committee the bill is intended to give consumers more affordable options when direct-to-consumer platforms offer lower prices than insurance. "If a drug is cheaper for a person to access through their insurance plan, that's great. But if a direct to consumer platform offers the same drug at a larger discount, the person should have the option to purchase the drug at the cheaper price and then have it count towards their out of pocket maximum or deductible," he said.

Co-prime sponsor Representative Lindsey said the bill does not change plan coverage rules: if a drug is not on a person's formulary, it would not become covered by this change, and utilization management such as step therapy and prior authorization remains in effect. Lindsey cited examples during remarks of manufacturers offering drugs at deep discounts and urged support.

Jill Mullen, a policy advisor at the Division of Insurance, testified in strong support and cited Colorado Health Access survey data: "This survey found in 2025 that 12 percent of Coloradans didn't get needed prescription medicine in the last year due to cost. This equates to about 700000 people," she told the committee.

Rebecca Gillette of the Chronic Care Collaborative, testifying for patient advocates, said the change would help people living with chronic conditions by allowing them to price-shop at licensed pharmacies and have those payments count toward deductibles and out-of-pocket maximums.

Committee members raised implementation questions: how carriers would process receipts, whether buying direct could be denied under current rules, and whether insurers might adjust their pricing or deductibles in response. Basenacker and witnesses said the bill includes a process (including submitting a receipt within 90 days and remaining within the current plan year) and noted that direct-to-consumer purchases are presently treated as out-of-network and would not be credited absent statute.

The committee voted 8–5 to send SB 26-167 to the Committee of the Whole with a favorable recommendation.