LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6648 NOTE PREPARED: Dec 28, 2019
BILL NUMBER: HB 1141 BILL AMENDED:
SUBJECT: Birth Control Prescriptions.
FIRST AUTHOR: Rep. Fleming BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: X GENERAL IMPACT: State & Local
DEDICATED
X FEDERAL
Summary of Legislation: This bill allows pharmacists to prescribe and dispense self-administered oral
hormonal contraceptives and hormonal contraceptive patches (contraceptives). The bill establishes
requirements for pharmacists who want to prescribe and dispense contraceptives. It also requires health plans
to provide coverage for contraceptives and certain services. It establishes an exception for nonprofit religious
employers.
Effective Date: July 1, 2020.
Explanation of State Expenditures: Summary - Allowing pharmacists to prescribe contraceptives to
patients, regardless of whether the patient has had a previous prescription from another prescriber, may result
in additional contraceptive claims within the Medicaid and state employee health care plans. This impact is
expected to be minimal. The bill would require the Board of Pharmacy to adopt rules regarding pharmacist
prescriptions for contraceptives, as well as notify licensees of the new prescriptive authority and training
requirements. These functions would likely be able to be accomplished within the Board’s regularly
scheduled business meetings under existing staffing and resource levels.
Under current federal and state policy, the bill’s requirement that health plans cover prescription
contraceptives is not expected to impact state expenditures. The federal Patient Protection and Affordable
Care Act (ACA) required virtually all health insurance plans to cover contraception as preventative care. The
state employee health insurance plans and Medicaid plans currently offer contraceptive coverage to all
female plan members without cost-sharing.
Additional Information - Potential Federal Rule Change: Federal rules issued in 2017 allowed employers
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to invoke a religious objection to the ACA’s contraceptive coverage mandate. Enforcement of these rules
has since been halted by federal courts, though litigation is ongoing. Under the ACA, states are responsible
for financing state mandated benefits that are not considered essential health benefits. If the federal religious
objection rules were to take effect, the state could be liable for the costs of contraceptive coverage in
instances where an employer has filed a religious objection to maintaining contraceptive coverage but their
insurer is required to do so under the bill’s provisions.
State Employee Health Plans: [An information request for the State Personnel Department relating to
provisions of this bill is currently pending]. Any increase in costs to the state employee health plans may not
necessarily imply additional budgetary outlays since the state's response to increased health benefit costs may
include (1) greater employee cost-sharing in health benefits; (2) reduction or elimination of other health
benefits; and (3) passing costs onto workers in the form of lower wage increases than would otherwise occur.
Medicaid State Share: Medicaid is jointly funded between the state and federal governments. The state share
of costs for most Medicaid medical services for FFY 2020 is 34%, or 10% for the age 19 to 64 expansion
population within the HIP program. The state share of administrative costs is 50%.
Explanation of State Revenues: Summary - To the extent insurance companies increase premiums collected
in the state due to additional claims for prescription contraceptives, General Fund revenue will increase from
either insurance premium tax collections or adjusted gross income (AGI) tax collections. Any additional
revenue is expected to be minimal.
Additional Information - Domestic health insurers have the option to pay taxes on insurance premiums
written in the state or to pay the AGI tax. Foreign insurers are required to pay taxes on premiums written in
the state, and some foreign insurers are assessed additional retaliatory taxes. In these cases, the minimum tax
rate would be 1.3% of written premiums. Revenue received from the AGI and insurance premium tax is
deposited in the General Fund. For FY 2019, the insurance premium tax generated approximately $251.6
M in revenue.
Explanation of Local Expenditures: Local units of government that provide health insurance plans for
employees may see increases in cost or premiums as a result of increased prescription contraceptive claims.
Any additional costs are expected to be minimal.
Explanation of Local Revenues:
State Agencies Affected: Professional Licensing Agency, Board of Pharmacy; Family and Social Services
Administration, Office of Medicaid Policy and Planning; State Personnel Department; Department of
Insurance.
Local Agencies Affected: Local units of government that provide health insurance plans for employees
Information Sources:
https://www.hhs.gov/about/news/2018/11/07/fact-sheet-final-rules-on-religious-and-moral-exemptions-an
d-accommodation-for-coverage-of-certain-preventive-services-under-affordable-care-act.html
Fiscal Analyst: Adam White, 317-234-1360; Bill Brumbach, 317-232-9559.
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