Fiscal Note
BILL # HB 2823 TITLE: AHCCCS; nonopioid drugs; formulary
SPONSOR: Biasiucci STATUS: As Introduced
PREPARED BY: Chandler Coiner
Description
This bill would require the Arizona Health Care Cost Containment System (AHCCCS) to ensure that a nonopioid drug that is
approved by the federal Food and Drug Administration (FDA) to treat or manage pain is not treated less favorably on the
system's drug formulary relative to any opioid or narcotic drug used to treat or manage pain. The bill defines "treated less
favorably" as establishing more restrictive utilization controls for a nonopioid drug than the utilization controls for an
opioid or narcotic drug, including prior authorization requirements and step therapy, or designating a nonopioid drug as
nonpreferred if an opioid or narcotic drug is designated as preferred.
Estimated Impact
We estimate that this bill would have a minimal fiscal impact given that the AHCCCS drug formulary appears to be mostly
in compliance with the bill's requirements. The exact fiscal impact would depend on how AHCCCS would interpret the bill
and implement changes to its formulary in response. AHCCCS would have the ability to implement the bill in a manner
which could either raise or lower their costs. AHCCCS has not yet responded to our request for its estimate of the bill's
fiscal impact.
Analysis
Prior authorization and step therapy protocols are utilization controls commonly used by health insurers and their
contractors to limit coverage of medications and services until certain requirements are met. Prior authorization requires
the member to meet certain criteria before a health insurer will cover certain medications or services. These can include
the presence of certain health conditions in the member, informational disclosures, and alternative treatments. A step
therapy protocol specifically requires the member to take 1 or more alternative medications that fail to treat the
member's condition before the insurer covers the prescribed medication.
Under this bill, if any nonopioid drug on AHCCCS' formula has utilization controls that are more restrictive than the
utilization controls for an opioid or narcotic drug, then AHCCCS would need to adjust its formulary policies. AHCCCS could
potentially implement the bill by using stricter utilization controls on the affected opioid or narcotic drugs. This would
likely reduce utilization and lower AHCCCS costs. Alternatively, AHCCCS could lift restrictions on the affected nonopioid
drugs, potentially increasing utilization and raising AHCCCS costs. The bill does not specify which of these approaches
AHCCCS would be required to take.
Local Government Impact
None
2/19/25