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Colorado moves to cap price of arthritis drug Enbrel in first-in-the-nation action by state affordability board

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Colorado moves to cap price of arthritis drug Enbrel in first-in-the-nation action by state affordability board


A Colorado board voted to move forward with setting a price ceiling on the arthritis drug Enbrel on Friday, a first-in-the-nation step that raises questions about whether a single state can reduce drug costs without unintended consequences.

Colorado would be the first to set a price ceiling on any drug, meaning the state can’t look to others for clues to how drugmakers and other players will respond. Opponents of the process say patients could lose access to drugs under a price ceiling, while supporters say drugmakers can’t easily cut states out of their distribution chains and still make money.

The vote by the Prescription Drug Affordability Board kicks off a six-month process to determine what price would be appropriate for Enbrel. The board also has the option to ultimately vote against a price ceiling at the end of the process.

The move by the state board is different than the Colorado legislature’s limits on how much customers pay out-of-pocket for insulin or EpiPens, as an Enbrel price ceiling would also apply to how much pharmacies pay to stock the drug.

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The board previously had determined the drug cost about $46,000 for one patient to take it for one year in 2022, with patients responsible for an average of $2,295 in Colorado if they have commercial insurance or Medicare Advantage. Some patients pay less because they qualify for assistance programs to cover their out-of-pocket costs.

The vote came one day after a state Senate committee voted to advance a bill that would remove all medications that have an “orphan drug” designation from the board’s list to consider in future years. The orphan status means a drug is approved for a rare condition, meaning it may not be profitable for drugmakers to develop such treatments.

The Colorado Consumer Health Initiative estimated that about 400 of the 600 drugs that the board identified as possibilities for review have orphan drug status for at least one condition.

Enbrel, which is approved for six conditions, has an orphan drug designation for one of them, polyarticular juvenile idiopathic arthritis.

Friday’s meeting capped a months-long process of reviewing data about how much Enbrel costs, and how much patients typically pay.

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Drugmaker Amgen and some patient groups criticized the board’s reliance on a survey that garnered responses from only 38 patients in Colorado to determine that the drug isn’t broadly affordable. Eight of those respondents said they went into debt because of their drug costs, 20 said they had to cut back on other expenses and nine said they sometimes stretched their doses to save money.

The board previously voted that the cystic fibrosis drug Trikafta and the HIV antiviral Genvoya both are affordable to patients because of assistance programs from drug manufacturers or the federal government. Neither drug will be subject to a price ceiling.

Cosentyx and Stelara, which both treat conditions where the body attacks its own tissues, will undergo affordability reviews later this year. The board’s charge is to determine if drugs are affordable to patients, not to the system as a whole.

Earlier in the review process, some trade groups had raised concerns about implementing a maximum price.

The Colorado Hospital Association said it worried that its members could be reimbursed less than the cost of drugs they buy if the board set upper payment limits. In a comment sent last year, the association said some of its members are part of multi-state purchasing groups, so they wouldn’t necessarily be able to buy drugs below the price ceiling, but insurance would still reimburse them at the rate the state set.

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The Colorado Pharmacists Society also sent a comment with concerns that its members wouldn’t be able to recoup the costs of stocking drugs that require more complicated handling, while the Colorado Association of Health Plans said insurers might not be able to change their formularies to bring patients’ out-of-pocket costs down to whatever level the board sets.

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Mild temperatures for the week ahead in Denver

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Mild temperatures for the week ahead in Denver



Mild temperatures for the week ahead in Denver – CBS Colorado

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3 Colorado Powerball lottery players won millions in March

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3 Colorado Powerball lottery players won millions in March


Three Coloradans became millionaires this month after winning big on Powerball lottery tickets bought in Denver, Loveland and Pueblo, according to a news release from Colorado Lottery.

One winner, identified as “Sean S.” in the release, played the same numbers used by his grandfather when the latter bought a Quick Pick ticket shortly before his death in 2018.

The numbers — 11-18-23-38-60 — netted Sean S. a $1 million prize on St. Patrick’s Day, which he learned of after receiving a notification on his phone.

He told Colorado Lottery that he plans to put most of the money toward retirement but may spend some on home improvements and a new car.

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“A Corvette would be my favorite,” he said in the release. “But since I have two kids, maybe just a new Tahoe. It’s functional.”

Sean S. bought his ticket in Pueblo. A $2 million ticket was also sold in Denver, and a $100,000 ticket was sold in Longmont ahead of the March 19 Powerball drawing. The March 12 drawing also produced winners, including a $1 million ticket sold in Loveland and a $100,000 ticket sold in Rangely.

The Powerball jackpot had climbed to $444 million as of Saturday morning, with the next drawing scheduled for 8:59 p.m.



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Colorado dad who uncovered child custody expert’s allegedly fake psychology degree concerned for other families: “It’s heartbreaking”

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Colorado dad who uncovered child custody expert’s allegedly fake psychology degree concerned for other families: “It’s heartbreaking”


Having to fight for custody of his children was nightmare enough for Chad Kullhem.

“It was really scary,” he said.

The experience was made worse by the family investigator working on his case.

“I had no way of knowing if anyone would hear me,” he added.

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CBS Colorado’s Karen Morfitt interviews Chad Kullhem.

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Shannon McShane was responsible for evaluating Kullhem and his ex-wife and then recommending custody. He says from the beginning something felt off. He filed a complaint with the Colorado Department of Regulatory Agencies, also known as DORA.

The agency gave him McShane’s credentials, including the Ph.D. she claimed to have received from a university in London, but the transcript didn’t check out and he went to directly to that university with questions.

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“They said ‘Yeah, we don’t have, like …’ she put letter grades on there for her doctorate. They were like ‘We don’t do letter grades for doctorate. We don’t have these programs the way that she did it,’ ” he said. “So that was the evidence I had.”

McShane had used those allegedly fake documents to become a licensed psychologist and addiction counselor in the state of Colorado. It was the key to having her name added to a statewide court roster of qualified family investigators, and it led to jobs with the Colorado Department of Corrections and Colorado Department of Human Services, where she worked at the Colorado Mental Health Institute at Pueblo hospital for five years.

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Shannon McShane

Denver Police Department


“It’s absolutely heartbreaking that someone can get a doctorate, that someone can get their license, falsify their credentials, get into a powerful position with the court,” Kullhem said.

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CBS Colorado asked DORA about their vetting process when someone applies for a professional license.

In a statement a spokesperson said in part, “If someone is educated in the U.S. the division verifies all information with U.S. institutions. In this case, Ms. McShane was educated outside of the United States. When this is the case, all documents go through a third-party equivalency review which deemed them to be substantially equivalent to training at a U.S. accredited institution.”

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CBS Colorado took that same question to both state departments that hired McShane, who say as partnering state agencies, they rely on DORA’s vetting process.

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A spokesperson for Corrections added “I can confirm that we verified her credentials in accordance with this process.” And, in a statement, the Department of Human Services said “the hospital completed a primary source verification, which is where the hospital and the Department of Regulatory Agencies confirm licensure as opposed to relying on the candidate providing a copy.”

Eventually, Colorado’s Attorney General launched an investigation, which ended in a 15-count criminal indictment with charges including forgery and attempting to influence a public official.

“She impacted a lot of people,” Kullhem said.

He’s now watching the criminal case closely, but his concern is with other families and warns them to do their research.

“I’m sure there are people out there who are permanently affected by this who don’t have any idea what to do,” he said.

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CBS Colorado asked DORA if any changes have been made. A spokesperson said in part: “The Division’s internal process was re-examined after Ms. McShane’s transcripts were called into question. No immediate internal process changes were needed; however, the Division is continuing to examine how it can better ensure the validity of documents approved by outside entities.”

A request for comment from McShane for this story was unanswered. She will return to court in April.



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