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January 26, 2023 HB 23-1002
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 23-0428
Rep. Mabrey; Jodeh
Sen. Roberts
Date:
Bill Status:
Fiscal Analyst:
January 26, 2023
House Health & Insurance
Shukria Maktabi | 303-866-4720
shukria.maktabi@coleg.gov
Bill Topic: EPINEPHRINE AUTO-INJECTORS
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☒ State Diversion
☒ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill caps the amount an insurance carrier may require a covered person to pay for
an epinephrine auto-injector at $60, and creates an epinephrine auto-injector
affordability program in the Department of Regulatory Agencies. It increases state
expenditures, requires a state diversion, and may increase state revenue beginning in
FY 2023-24.
Appropriation
Summary:
For FY 2023-24, the bill requires an appropriation of $58,291 to the Department of
Regulatory Agencies.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Table 1
State Fiscal Impacts Under HB 23-1002
Budget Year
FY 2023-24
Out Year
FY 2024-25
Revenue - -
Expenditures Cash Funds $58,291 $60,090
Centrally Appropriated $12,317 $14,340
Total Expenditures $70,608 $74,430
Total FTE 0.7 FTE 0.8 FTE
Transfers/Diversions General Fund ($70,608) ($74,430)
Cash Fund $70,608 $74,430
Net Diversion $0 $0
Other Budget Impacts - -
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January 26, 2023 HB 23-1002
Summary of Legislation
Epinephrine auto-injector affordability program. Beginning January 1, 2024, the bill creates an
epinephrine auto-injector affordability program in the Department of Regulatory Agencies (DORA)
to provide low-cost epinephrine auto-injectors to eligible individuals in the state. The bill outlines the
individuals eligible to participate in the program and requires the Division of Insurance (DOI) within
DORA to create an application form for the program. This form is to be made available and promoted
on both the DOI and the Department of Health Care Policy and Financing’s (HCPF) websites, and
each department can seek gifts, grants, and donations for this purpose.
Manufacturers of epinephrine auto-injectors must make injectors available to individuals in the
program and are required to either reimburse pharmacies for the difference between the wholesale
acquisition cost and the amount paid by program participants, or provide the same number of
injectors to the pharmacy. Manufacturers are required to develop a process for a pharmacy to submit
a reimbursement claim and non-compliant manufacturers are subject to fines.
Cost of an epinephrine auto-injector. The bill requires that insurance carriers providing coverage for
epinephrine auto-injectors must cap the total cost to the covered person at $60 for a 2-pack of the
injectors. Additionally, pharmacies dispensing injectors through the affordability program are
permitted to collect a copayment of no more than $60 for a 2-pack of injectors to cover their processing
and dispensing costs. DORA may also use enforcement powers to ensure compliance and promulgate
rules as necessary.
State Revenue
The bill may increase revenue from gifts, grants, and donations to DORA or HCPF, which are exempt
from TABOR revenue limits. However, no specific sources have been identified at this time. State
revenue may also increase from fines, which are subject to TABOR, when manufacturers fail to comply
with the bill's requirements. The fiscal note assumes that manufacturers will generally follow the law,
and any fine revenue will be minimal.
State Diversions
This bill diverts $70,608 from the General Fund in FY 2023-24 and $74,430 in FY 2024-25. This revenue
diversion occurs because the bill increases costs in the DOI in DORA, which is funded with premium
tax revenue that would otherwise be credited to the General Fund.
State Expenditures
The bill increases expenditures in DORA by $70,608 in FY 2023-24 and $74,430 in FY 2024-25, paid
from the DOI Cash Fund. Expenditures are shown in Table 2 and detailed below. The bill also
increases workload in HCPF, state pharmacies, and the Department of Law.
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January 26, 2023 HB 23-1002
Table 2
Expenditures Under HB 23-1002
FY 2023-24 FY 2024-25
Department of Regulatory Agencies
Personal Services $49,176 $59,010
Operating Expenses $945 $1,080
Capital Outlay Costs $6,670 -
Translation Services $1,500 -
Centrally Appropriated Costs
1
$12,317
$14,340
Total Cost $70,608 $74,430
Total FTE 0.7 FTE 0.8 FTE
1
Centrally appropriated costs are not included in the bill's appropriation.
Division of Insurance, DORA. The DOI will require program staff and translation services, as
described below.
Program staff. The DOI will hire 0.8 FTE to review application forms and rates to ensure
compliance, handle inquires and complaints about the program, develop new regulations and
enforcement mechanisms, and develop and promote a new application form and promotional
materials for the program. Staff costs are prorated for a September 1 start date, and include
standard capital outlay and operating expenses.
The fiscal note assumes inquiries will continue for at least the first three years of implementation
as affected parties become aware of the program. These functions and FTE estimates are based on
similar affordability programs within the DOI. As such, staffing needs are expected to end in
FY 2026-27.
Translation. The DOI will require a one-time cost to contract for translation services to make the
application available in at least three languages. These costs may be greater depending on the
language needs of different counties; any additional resources will be requested through the
budget process.
Department of Health Care Policy and Financing. Workload will increase in HCPF to update its
website and promote the program. No change in appropriations is required.
Department of Law. The Department of Law may experience a minimal increase in workload to
provide rulemaking support to the DOI and legal support to the DOI and HCPF for the development
and publication of the application. The fiscal note assumes manufacturer compliance; however, if legal
services are required, this will be addressed through the annual budget process.
Office of Information Technology. Workload in the Office of Information Technology will minimally
increase to facilitate the posting of an application form on agency websites. Page 4
January 26, 2023 HB 23-1002
State pharmacies. State-operated pharmacies in the departments of Corrections, Higher Education,
and Human Services may experience increased workload to process reimbursement or replacements
of auto-injectors with manufacturers. No change in appropriations is required.
Effective Date
The bill takes effect 90 days following adjournment of the General Assembly sine die, assuming no
referendum petition is filed.
State Appropriations
For FY 2023-24, the bill requires an appropriation of $58,291 from the Division of Insurance Cash Fund
to the Department of Regulatory Agencies, and 0.7 FTE.
State and Local Government Contacts
Corrections Health Care Policy and Financing Higher Education
Human Services Information Technology Law
Public Health and Environment Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.