Division of the Budget
Landon State Office Building Phone: (785) 296-2436
900 SW Jackson Street, Room 504 larry.campbell@ks.gov
Topeka, KS 66612 Division of the Budget http://budget.kansas.gov
Adam Proffitt, Director Laura Kelly, Governor

February 3, 2021

The Honorable Brenda Landwehr, Chairperson
House Committee on Health and Human Services
Statehouse, Room 352C-S
Topeka, Kansas 66612
Dear Representative Landwehr:
SUBJECT: Fiscal Note for HB 2157 by House Committee on Health and Human
In accordance with KSA 75-3715a, the following fiscal note concerning HB 2157 is
respectfully submitted to your committee.
HB 2157 would require health insurance plans to consider available recognized evidence-
based and peer-reviewed clinical practice guidelines when establishing a step therapy protocol.
Step therapy protocol is defined as a protocol or program that establishes the specific sequence in
which prescription drugs for a specified medical condition, including self-administered and
physician-administered drugs, are medically appropriate for a particular patient and are covered
under a health insurance plan.
The bill would require a clear, readily accessible and convenient process to request a step
therapy exception and outlines when a health insurance plan would grant an override to the step
therapy protocol. The patient or prescriber could appeal the denial of a step therapy exception. A
health insurance plan could require a patient to try a generic equivalent drug prior to providing
coverage for equivalent branded prescription drugs. The bill would not mandate coverage for
prescription medication if the coverage is not already a covered benefit by the patient’s health
insurance plan.
The Department of Administration estimates enactment HB 2157 would increase costs to
the State Employee Health Plan by $2.6 million from special revenue funds in FY 2022. The
estimate assumes a first-year annual cost increase of $5.2 million. However, because the bill’s
provisions would not go into effect until January 1, 2022, only half of the annual cost would apply
to FY 2022. The Department estimates the cost would increase to $5.6 million in FY 2023 which
assumes a cost and usage increase of $442,000 or 8.5 percent.
The Honorable Brenda Landwehr, Chairperson
Page 2—HB 2157

The Insurance Department states that enactment of the bill would have no fiscal effect on
Department operations. Any fiscal effect associated with HB 2157 is not reflected in The FY 2022
Governor’s Budget Report.


Adam Proffitt
Director of the Budget

cc: Bobbi Mariani, Insurance
Jeff Scannell, Department of Administration