OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http://www.cga.ct.gov/ofa

sHB-6320

AN ACT CONCERNING HEALTH INSURANCE COVERAGE OF ORALLY AND INTRAVENOUSLY ADMINISTERED MEDICATIONS.


OFA Fiscal Note

State Impact: None – See Below

Municipal Impact:

Municipalities

Effect

FY 14 $

FY 15 $

Various Municipalities

STATE MANDATE - Cost

Potential

Potential

Explanation

The bill requires orally-administered medications for patients with disabling or life threatening chronic diseases to be covered on the same basis as intravenously administered medications. This provision of the bill is not anticipated to impact costs to the state employee and retiree health plans since the state's pharmacy benefit manager currently covers oral medications with a required copayment.1

The bill's provisions may increase costs to fully-insured municipal plans which do not currently offer the coverage mandated. The coverage requirements may result in increased premium costs when municipalities enter into new health insurance contracts on or after January 1, 2014. Due to federal law, municipalities with self-insured health plans are exempt from state health insurance benefit mandates.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

Sources:

Office of the State Comptroller

1 The state employee and retiree health plans have a three tier pharmacy copayment: Tier 1- Generic $5, Tier 2 – Preferred brand name $10/$20 non maintenance, Tier 3 – Non-preferred brand name $25/$35 non maintenance. Members enrolled in the Health Enhancement Program (HEP) receive reduced copayments on medications used to treat chronic conditions covered by HEP.