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 7411 NOTE PREPARED: Jan 6, 2021
BILL NUMBER: HB 1379 BILL AMENDED:
SUBJECT: Pharmacist Contraceptive Prescriptions.
FIRST AUTHOR: Rep. Ziemke BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: X GENERAL IMPACT: State & Local
X 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. The bill requires the
Indiana Board of Pharmacy to adopt rules. It requires health plans to provide coverage for contraceptives and
certain services. It establishes an exception for nonprofit religious employers.
Effective Date: July 1, 2021.
Explanation of State Expenditures: 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 also require the Board of Pharmacy, in consultation with the Medical
Licensing Board and State Department of Health, 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 Boards’ regularly scheduled business meetings
under existing staffing and resource levels.
The bill’s requirement that health plans cover prescription contraceptives may result in an indeterminable
increase in state expenditures. The federal Patient Protection and Affordable Care Act (ACA) requires
virtually all health insurance plans to cover contraception as an essential health benefit. The state employee
health insurance plans and Medicaid plans currently offer contraceptive coverage to all female plan members
without cost-sharing. However, a recent federal rule change allows certain employers to request a religious
or moral exemption from offering contraceptive coverage. The state could then become liable under the ACA
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for the costs of state-mandated contraceptive coverage for employers that file a religious or moral objection.
The bill exempts religious nonprofit employers from the coverage mandate, but the number of other
employers that may file a religious or moral exemption is currently indeterminate.
Additional Information - Federal Rule Change: A new federal rule upheld by the U.S. Supreme Court in
2020 allows employers to invoke a religious or moral objection to the ACA’s contraceptive coverage
mandate. Under the ACA, states are responsible for financing state mandated benefits that are not considered
essential health benefits. Therefore, the state could be liable for the costs of contraceptive coverage in
instances where an Indiana employer has filed a religious or moral objection to maintaining contraceptive
coverage but their health plan is required to do so under the bill’s provisions. The bill exempts religious
nonprofits from the coverage mandate, but the recent Supreme Court ruling also extends the ability to invoke
a religious or moral objection to for-profit and secular nonprofits.
State Employee Health Plans: Costs for the state health plans are shared between the state and state
employees covered by the plan as determined in the plans’ designs, including premiums, coinsurance,
copayments, and deductibles. An increase in premiums cost may be mitigated with adjustments to other
benefits or to employee compensation packages, or through the division of premium costs between the state
and state employees.
Medicaid State Share: Medicaid is jointly funded between the state and federal governments. The standard
state share of costs for most Medicaid medical services for FFY 2021 is 34%, or 10% for the age 19 to 64
expansion population within the Healthy Indiana Plan. The state share of administrative costs is 50%. Under
federal COVID-19 relief legislation, the state share of costs is decreased to 28% for traditional Medicaid
enrollees for the duration of the federally declared public health emergency.
Explanation of State Revenues: An increase in private insurance claims for prescription contraceptives may
create upward pressure on premiums collected in the state. Any increase in insurance company premiums
will increase General Fund revenue from either insurance premium tax collections or Adjusted Gross Income
(AGI) tax collections. Any increase in revenue as a result of this bill is expected to be minimal.
Explanation of Local Expenditures: Local units of government that provide non-ERISA 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, Medical Licensing Board;
State Department of Health; 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 non-ERISA health insurance plans for
employees.
Information Sources:
https://khn.org/news/high-court-allows-employers-to-opt-out-of-acas-mandate-on-birth-control-coverage/
Fiscal Analyst: Adam White, 317-234-1360.
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