Subject: Drugs and Controlled Substances; Insurance - General; insurance - Medical; Pharmacy

Bill Summary: Allows enrollees to pay the lower of the copayment assigned by the health maintenance organization or health insurer or the usual and customary retail price of the prescription drug.

ESTIMATED NET EFFECT ON GENERAL REVENUE FUND
FUND AFFECTED	FY 2009	FY 2010	FY 2011


Total Estimated Net Effect on General Revenue Fund	$0	$0	$0

ESTIMATED NET EFFECT ON OTHER STATE FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011
Insurance Dedicated	Up to $5,000	$0	$0

Total Estimated Net Effect on Other State Funds	Up to $5,000	$0	$0

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011


Total Estimated Net Effect on All Federal Funds	$0	$0	$0

ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)
FUND AFFECTED	FY 2009	FY 2010	FY 2011


Total Estimated Net Effect on FTE	0	0	0

☐ Estimated Total Net Effect on All funds expected to exceed $100,000 savings or (cost).

☐ Estimated Net Effect on General Revenue Fund expected to exceed $100,000 (cost).

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 2009	FY 2010	FY 2011
Local Government	$0	$0	$0

Officials from the Department of Public Safety (DPS) - Director’s Office defer to the Missouri Consolidated Health Care Plan for response regarding the potential fiscal impact of this proposal on their organization.

Officials from the DPS - Missouri State Highway Patrol (MHP) defer to the Missouri Department of Transportation for response regarding the potential fiscal impact of this proposal on their organization.

Officials from the Missouri Department of Transportation (DOT) state the proposal will have no fiscal impact on the Missouri Highways and Transportation Commission or DOT. The legislation will also have no fiscal impact on the DOT/MHP Medical Plan (Plan), since it only applies to HMO’s and health insurers and not to self-insured governmental plans.

Officials from the Missouri Consolidated Health Care Plan (HCP) state that currently under the HCP contract, if the co-payment amount is higher than the cost of the drug, the member pays the cost of the drug. Therefore, this proposal will have no fiscal impact on the HCP.

Officials from the Missouri Department of Conservation (MDC) state the proposed legislation would not appear to have a fiscal impact on MDC funds since the MDC insurance plan already requires members to be charged the lower of the typical prescription drug co-payment or the actual cost of the drug.

Officials from the Department of Insurance, Financial and Professional Regulation (DIFP) estimate up to100 insurers may be required to submit amendments to their policies to comply with the legislation. Policy amendments must be submitted to the department for review along with a $50 filing fee. One-time additional revenues to the Insurance Dedicated Fund are estimated to be up to $5,000 (up to 100 insurers X $50).

Additional staff and expenses are not being requested with this single proposal, but if multiple proposals pass during the legislative session which require policy form reviews, the DIFP will need to request additional staff to handle the increase in workload.

The proposal may impact small businesses that provide prescription insurance coverage for their employees if HMOs or health insurers adjust premiums as a result of this proposal.

This proposal specifies that when the usual and customary retail price of a prescription drug is less than the co-payment applied by a health maintenance organization or health insurer, the

enrollee is only required to pay the usual and customary retail price of the prescription drug.

This legislation is not federally mandated, would not duplicate any other program and would not require additional capital improvements or rental space.

FISCAL IMPACT - State Government	FY 2009 (10 Mo.)	FY 2010	FY 2011
INSURANCE DEDICATED FUND

Income - DIFP
Form filing fees	Up to $5,000	$0	$0

ESTIMATED NET EFFECT ON INSURANCE DEDICATED FUND	Up to $5,000	$0	$0