OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

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

sHB-7052

AN ACT PREVENTING PRESCRIPTION OPIOID DIVERSION AND ABUSE.

As Amended by House "A" (LCO 8124)

House Calendar No.: 155


OFA Fiscal Note

State Impact:

Agency Affected

Fund-Effect

FY 18 $

FY 19 $

State Comptroller - Fringe Benefits (State Employee and Retiree Health Plan)

GF&TF - See Below

See Below

See Below

Note: GF&TF=General Fund & Transportation Fund

Municipal Impact:

Municipalities

Effect

FY 18 $

FY 19 $

Various Municipalities

See Below

See Below

See Below

Explanation

The bill results in the fiscal impact described below:

Section 5 of the bill may result in a savings to the state employee and retiree health plan and fully insured municipal plans from limiting opioid prescriptions to five days for a minor. Current law limits the prescription to seven days. The savings will depend on the reduction in the number of pills dispensed to covered members in the state employee and retiree health plan. The savings for fully-insured municipalities will be reflected in future premiums.

Since the seven day limit was enacted in 2016, the average day supply for a first prescription in the state plan went from 12 days to approximately 7. The average day supply was the highest in 2012 at approximately 86 days. The average per member per month cost of certain opioids prescribed in a 1-30 supply ranged from $3.70 to $41.20 (for an average of $13.34) for approximately 22,500 members.

Section 9 of the bill is not anticipated to result in a cost to the state and retiree health plan as the state plan currently provides coverage for medically necessary inpatient detoxification as subject to prior authorization which is not in conflict with the coverage requirements of the bill.1 The bill may increase costs to certain fully insured, municipal plans that do not currently comply with the coverage requirements required by the bill for certain inpatient detoxification services. The coverage requirements may result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2018. In addition, many municipal health plans are recognized as “grandfathered” health plans under the ACA.2 It is unclear what effect the adoption of certain health mandates will have on the grandfathered status of certain municipal plans under ACA.

Section 11 of the bill is expected to have no fiscal impact. This section clarifies the minimum number of emergency responders from each municipality that must be equipped and trained to administer opioid antagonists. Municipalities are already required to train and equip a medical responder to administer opioid antagonists. There is expected to be no change, to the extent that towns choose not to exceed the mandated minimum.

The bill specifies other administrative and process provisions that are not expected to result in a fiscal impact to the state or municipalities.

House “A” struck the underlying bill and its associated fiscal impact and results in the fiscal impact described herein.

The Out Years

The fiscal impact identified above will continue into the out years and be reflected in state health plan expenditures or for fully insured municipal plans, in future premiums.

1 The state employee and retiree health plan is a self-insured health plan. Pursuant to federal law, self-insured health plans are exempt from state health mandates. However, the state plan has traditionally adopted all state health mandates.

2 Grandfathered plans include most group insurance plans and some individual health plans created or purchased on or before March 23, 2010.