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For the second time in two years, a bill is moving through the Colorado legislature that would exempt orphan drugs, which are used to treat rare diseases, from pricing caps that might be pursued by the state’s Prescription Drug Affordability Board — a panel whose work is being closely watched elsewhere in the country. The effort reflects concerns that patients may lose access to these drugs if pharmaceutical companies halt sales of such treatments in the state. But opponents argue exemptions would unnecessarily extend to numerous big-selling medicines for common conditions that — thanks to regulatory endorsements — also happen to have an orphan designation. (Silverman, 4/6)

As the Medicaid cuts from H.R. 1 begin to settle in, states are looking for workarounds to continue funding their programs. Iowa Republican Gov. Kim Reynolds signed a bill March 25 allowing a steeper HMO tax, which will also affect managed care organizations, to bolster the state’s Medicaid program. The tax would not be levied on just HMO premiums, but would instead apply to all taxable funds beyond those from federal HHS. With CMS’ approval, a 3.5% tax rate could be retroactively applied from January until September 2026. The rate would then drop to 0.95%. (Casolo, 4/6)

�������ýҕ�l Health News: This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit

Misty Pipe had about an hour before her shift began at the post office. She used that time to check in on a new mom who lives a few miles outside this town at the heart of the Northern Cheyenne Indian Reservation. A mom of seven, Pipe is a doula on the reservation who supports new and expectant parents. She does that work free, around her day job. That’s because in this town of about 2,000 people, the closest hospital that delivers babies is 100 miles away. “Women need this help,” Pipe said. (Houghton, 4/7)

The Supreme Court’s ruling last week against bans on conversion therapy is stirring debate around free speech, with critics pointing to inconsistencies in the standard applied to bans on abortion and drag shows. In its ruling on Colorado’s 2019 ban on conversion therapy in the case of Chiles v. Salazar, the Supreme Court found that a lower court had “erred” in upholding it because the law “regulates speech based on viewpoint.” (Choi, 4/7)