Colorado-specific provider and drug pricing information collected for the first time since passage of SB24-080
DENVER - Colorado achieved a major milestone last month in collecting pricing information from health insurance carriers following the passage of SB24-080 in 2024. This makes Colorado the first state in the country to successfully collect state-specific federal Transparency in Coverage data.
“Being able to easily find out pricing is an important part of giving consumers the information we need to make the best choices, and puts downward pressure on prices by boosting competition. This law gives consumers, employers and advocates the data needed to better understand pricing for drugs and services, and negotiate better prices for Coloradans,” said Governor Jared Polis.
Federal Transparency in Coverage standards went into effect in 2022, requiring health insurance carriers to report on their websites the underlying negotiated rates for all health care services and items, including prescription drugs, as well as three separate machine-readable files that include detailed pricing information. Carriers complied, but the data is notably difficult to parse through and download because federal rules did not require the data to be standardized, de-duplicated, or broken down by appropriate health care services.
Colorado’s data requirements will result in cleaner data that is easier to understand for the average consumer curious about costs. In 2024, the Colorado General Assembly passed SB24-080, which strengthens the federal rules and improves data collection for Colorado in three main ways:
- It requires Colorado-specific information
- It requires carriers to limit the files based on what codes providers actually use in an attempt to remove “ghost codes.” A ghost-code is when there is a medical billing code for a service or procedure that was likely never actually performed. For example, data showing that a podiatrist delivered a baby
- It requires that carriers provide price information for the most frequently used prescription drugs on their plans
“This is a huge first step for Colorado in demystifying health care pricing information for consumers,” said Colorado Insurance Commissioner Michael Conway. “Colorado’s law will dramatically improve data quality and allow the Division of Insurance, as well as academics and researchers, to better understand health care trends and barriers to lower prices. Colorado has been a trailblazer in improving consumer protections in health care and can now add transparency in coverage to the list.”
Now that Colorado’s Division of Insurance has collected the first round of transparency data, it will compile the data and make it available to consumers and researchers on the Transparency in Coverage webpage by early next year. The Division is also looking to information-share with researchers who may be interested in using this data for their academic pursuits that would help Coloradans better understand the data. Interested researchers should email dora_ins_data@state.co.us.
###