Capitol Impact: Inside Colorado's crackdown on "Big Pharma"

Editor's note: Colorado's General Assembly approved more than 500 bills this year. In this occasional series, we unpack what it means for you.

Democratic lawmakers declared a war on "Big Pharma" this year, and delivered a handful of major bills designed to bring down the cost of prescription drugs.

Why it matters: Colorado spent nearly $4 billion on prescription drugs in 2018, according to an analysis, which equates to 13% of all health care spending.

What's new: The most significant measure is the creation of a Prescription Drug Affordability Review Board — which Gov. Jared Polis signed Wednesday.

• The law allows a board of political appointees to set price limits for up to 12 prescription drugs annually for the first three years of the board's existence.

What else: Other legislation to reduce spending on prescription drugs ...

• Expands the still-pending Canadian drug importation program to include other countries, where drugs are often cheaper.
• Fixes a gap in current law that allowed pharmacies to get around a cap on insulin prices, and creates a fund to help those who can't afford it.
• Imposes new regulations on pharmacy benefit managers — the middlemen that process three-quarters of all prescriptions.
• Forces companies to compete for state drug contracts through a reverse auction.

What they're saying: "No one should have to choose between buying food or the prescriptions they need," Democratic Sen. Sonya Jaquez Lewis, a pharmacist who represents Boulder County, said in a press release.

Yes, but: Democratic leaders and advocates hailed the efforts as momentous, but their estimates of savings are exaggerated and include caveats.

• Most notably, the new state regulations may not help everyone because the state has limited regulatory authority over some employer-based plans.
• The new drug affordability board will cost taxpayers $4 million in the first seven years, legislative analysts estimate.
• If the board sets price limits at international rates, it may make the state's planned drug importation program  — which it has already spent about $2 million to develop — moot.

The other side: Medical providers and insurers warn that drug makers may pull their prescriptions from the market if price caps are imposed.

• "The reason I have concerns is that not only am I concerned that it's not going to fix that problem, but also that it's going to limit access to these very important medications," Kelly Greene, from Littleton Adventist Hospital told lawmakers earlier this year.