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PURPOSE OF HB 1276
To exempt antipsychotic prescription drugs from regulation under step therapy protocols.
ACTUARIAL STATEMENT
The Fiscal Impact Statement was prepared according to generally accepted actuarial principles and
practices, in compliance with ACT 112. The Statement provides an estimate of the financial and
actuarial effect of the proposed change(s) on the Plans, if possible. The Statement makes no
comment or opinion with regard to the merits of the measure for which the Statement is prepared;
however, any identified technical or mechanical defects have been noted.
We have reviewed the input and results of our analysis for reasonableness and relied upon the data
and information provided by the Plans and their Claims Processing Contractors.
3/10/2023
_________________________________________ _________________
Patrick Klein, FSA, MAAA Date
Vice President
3/10/2023
_________________________________________ __________________
Matthew Kersting, FSA, MAAA Date
Vice President
 PROJECTED COSTS
Plan Design Change Annual Estimated Cost
Plan
EBD No Change No Impact
UOA No Change No Impact
ASU Exempt Antipsychotic Prescription No Material Impact
Drugs from Step Therapy Protocols
UCA Exempt Antipsychotic Prescription No Material Impact
Drugs from Step Therapy Protocols
AHEC Exempt Antipsychotic Prescription No Material Impact
Drugs from Step Therapy Protocols
NWACC Exempt Antipsychotic Prescription No Material Impact
Drugs from Step Therapy Protocols
SAU Exempt Antipsychotic Prescription No Material Impact
Drugs from Step Therapy Protocols
PRICING APPROACH AND COMMENTS
House Bill 1276 exempts antipsychotic prescription drugs from regulation under step therapy
protocols. EBD and UOA both confirmed that they do not apply step therapy protocols to
antipsychotic prescription drugs. Step therapy is a protocol to control prescription drug medication
costs by having participants utilized preferred, and generally cheaper, medications before they
are able to have coverage for non-preferred medications. Based on the responses received from
the university system health plans, the SAU and UCA plans apply step therapy protocols to brand
name antipsychotic prescription drugs, meaning that participants must first utilize generic versions
of the brand name drug and experience inadequate treatment before the plan will provide
coverage for the associated brand name version of the antipsychotic drug.
The overall antipsychotic prescription utilization information we received from the plans showed
a high utilization of generic antipsychotic prescription drugs and a low overall utilization of
medications within this drug class. Based on the plan supplied antipsychotic prescription drug
utilization, for plan sponsors both with and without step therapy protocols in place, there is no
material impact expected for the remaining university system health plans.