Udall to unveil bill to aid those with chronic conditions | SummitDaily.com

Udall to unveil bill to aid those with chronic conditions

DENVER – U.S. Rep. Mark Udall, D-Colo., will outline Monday the details of a bill he says could save high-risk patients 40 percent on prescription drug costs.

According to Udall’s press secretary, Lawrence Pacheco, the bill would include high-risk pools under the federal government’s Public Health Service’s 340B program. A high-risk pool is a nonprofit organization created by state Legislatures to provide coverage for people who can’t get insurance because of high costs or pre-existing conditions. There are 30 such pools in the country; Colorado’s is called Cover Colorado.

The bill uses the federal government’s purchasing power to provide discounts on drugs for high-risk pools nationwide. Under the 340B program, Cover Colorado would be eligible to obtain prescription drugs at lower prices than on the free market – as would public and veteran’s hospitals, AIDS and STD clinics and community health centers.

If individuals in high-risk pools can’t get the drugs they need to manage their conditions, they could end up in emergency rooms and cost the taxpayers millions of dollars, Pacheco noted. Likewise, he said, if they aren’t covered under the risk pool, they would most likely end up on Medicaid or uninsured, also costing taxpayers millions of dollars. 

Last year, the federal government required high-risk pools to provide more coverage for clients. Udall’s bill would use the federal government’s purchasing power to provide discounts on drugs for high-risk pools nationwide. In turn, patients would be able to take care of themselves and save state governments money, Pacheco said.

It’s not cheap, he admitted.

For example, a 45-year-old, nonsmoking Summit County woman with a pre-existing condition would pay about $700 a month in premiums under Cover Colorado – 142 percent more than what it might cost on the free market. Today, that coverage does not include prescriptions.

“That leaves little money left for food, rent, prescription drugs,” Pacheco said. “This bill is meant to give them a break on their prescription pill price so they can manage their disease. This is the only place a lot of people can go in order to get coverage.”

The monthly premium costs might be high, Pacheco said, but on the free market, insurance companies might deny coverage to a patient with a pre-existing condition – or, as is increasingly common, people who have lost their jobs and insurance in the recession might go uninsured.

According to Pacheco, there are 153,000 people nationwide – of which 5,000 are Coloradans – in high-risk pools.

“It’s not a lot of people, but a lot have chronic conditions,” he said. “If they couldn’t afford to buy their medications, they’d end up in the emergency room. And that costs millions of dollars each year.

“I have heard stories about people with chronic conditions cutting their pills in half, choosing between paying for drugs and paying for food, or forgoing the medications altogether,” Udall said. “These folks shouldn’t be faced with these choices at all.”

Until recently, Cover Colorado was funded by the interest accrued from the state’s Unclaimed Property Fund. But legislators are diverting that money to offset the state’s budget deficit. Now, insurers will be charged assessments to cover Cover Colorado’s costs, Pacheco said.

“And they pass it on to employers and clients, and the employers pass it on to their employees,” he said.

Pacheco said almost 40 percent of Cover Colorado’s budget is spent on prescription drugs, and if the high-risk pools could obtain prescription drugs at discount prices, they could pass the savings on to their patients.

“This bill is good for the insurance market and consumers because high-risk pools stabilize health insurance coverage and reduce the number of uninsured,” Udall said. “It’s good for employers because if we control the costs of the high-risk programs, it will keep down the assessments that insurers and employers pay to fund the program. And it’s good for states because if we control the costs of the program, cash-strapped states won’t have to find additional funds to stabilize the risk pool, and the state’s contribution will go a lot further.”

Jane Stebbins can be reached at (970) 668-3998 ext. 228 or jstebbins@summitdaily.com.

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