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April 14, 2023 HB 23-1002
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated March 27, 2023)
Drafting Number:
Prime Sponsors:
LLS 23-0428
Rep. Mabrey; Jodeh
Sen. Roberts
Date:
Bill Status:
Fiscal Analyst:
April 14, 2023
Senate Appropriations
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 and local
workload beginning in FY 2023-24.
Appropriation
Summary:
For FY 2023-24, the bill requires an appropriation of $77,632 to the Department of
Regulatory Agencies.
Fiscal Note
Status:
This revised fiscal note reflects the reengrossed bill, as amended by the Senate Health
and Human Services Committee.
Table 1
State Fiscal Impacts Under HB 23-1002
Budget Year
FY 2023-24
Out Year
FY 2024-25
Revenue - -
Expenditures Cash Funds $77,632 $83,218
Centrally Appropriated $17,394 $19,773
Total Expenditures $95,026 $102,991
Total FTE 1.0 FTE 1.1 FTE
Diversions General Fund ($95,026) ($102,991)
Cash Fund $95,026 $102,991
Net Diversion $0 $0
Other Budget Impacts - -
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April 14, 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 reimburse pharmacies for the amount that the pharmacy paid the
manufacturer for the number of injectors dispensed through the program. Manufacturers are required
to develop a process for a pharmacy to submit a reimbursement claim and non-compliant
manufacturers are subject to fines. Failure to comply also constitutes a deceptive trade practice.
Manufacturers can be determined by DORA to meet the requirements of the affordability program if
the manufacturer has an affordability program in place or provides auto-injectors at a price of $60 for
a 2-pack of injectors. These manufacturers must apply and be approved by DORA.
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
State revenue may increase from civil penalties, filing fees, and gift, grants, and donations beginning
in FY 2023-24.
Civil penalties. The bill specifies that a manufacturer that fails to comply with the bill’s requirements
is subject to a fine of $10,000 for each month of noncompliance. Under the Colorado Consumer
Protection Act, a person committing a deceptive trade practice may be subject to a civil penalty of up
to $20,000 for each violation and additional penalties may be imposed for subsequent violations of a
court order or injunction. This revenue is classified as a damage award and not subject to TABOR.
Given the uncertainty about the number of cases that may be pursued by the Attorney General and
district attorneys, as well as the wide range in potential penalty amounts, the fiscal note cannot
estimate the potential impact of these civil penalties.
Filing fees. The bill may increase revenue to the Judicial Department from an increase in civil case
filings. Revenue from filing fees is subject to TABOR.
Gifts, grants, and donations. 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. Page 3
April 14, 2023 HB 23-1002
State Diversions
This bill diverts $95,026 from the General Fund in FY 2023-24 and $102,991 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 $95,026 in FY 2023-24 and $102,991 in FY 2024-25, paid
from the DOI Cash Fund. Expenditures are shown in Table 2 and detailed below. The bill also
increases workload for HCPF, the Department of Law, the Judicial Department, the Office of
Information Technology, and state pharmacies.
Table 2
Expenditures Under HB 23-1002
FY 2023-24 FY 2024-25
Department of Regulatory Agencies
Personal Services $68,112 $81,733
Operating Expenses $1,350 $1,485
Capital Outlay Costs $6,670 -
Translation Services $1,500 -
Centrally Appropriated Costs
1
$17,394
$19,773
Total Cost $95,026 $102,991
Total FTE 1.0 FTE 1.1 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 requires 1.1 FTE to review forms and rates to ensure compliance, handle
inquires and complaints, develop new regulations and enforcement mechanisms, develop and
promote a new application form and promotional materials for the program, and develop and
review application form for manufacturers. 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.
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April 14, 2023 HB 23-1002
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.
Workload will also minimally increase to the extent that deceptive trade practice complaints are filed.
The department will review complaints under the bill and prioritize investigations as necessary within
the overall number of deceptive trade practice complaints and available resources.
Judicial Department. The trial courts in the Judicial Department may have an increase in cases filed
under the Colorado Consumer Protection Act from the addition of a new deceptive trade practice. It
is assumed that entities will abide by the law and that any violation of the legislation will result in
minimal number of new cases. The fiscal note assumes that this can be accomplished within existing
resources and that no change in appropriations is required.
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.
State pharmacies. State-operated pharmacies in the departments of Corrections, Higher Education,
and Human Services may experience increased workload to process reimbursement of auto-injectors
with manufacturers. No change in appropriations is required.
Local Government
Similar to the state, to the extent district attorneys receive deceptive trade practice complaints related
to the new deceptive trade practice under the bill, workload will increase to investigate complaints
and seek relief when appropriate. It is assumed most such cases will be handled at the state level by
the Attorney General.
Effective Date
The bill takes effect 90 days following adjournment of the General Assembly sine die, assuming no
referendum petition is filed.
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April 14, 2023 HB 23-1002
State Appropriations
For FY 2023-24, the bill requires an appropriation of $77,632 from the Division of Insurance Cash Fund
to the Department of Regulatory Agencies, and 1.0 FTE.
State and Local Government Contacts
Corrections Health Care Policy and Financing Higher Education
Human Services Information Technology Judicial
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.