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 6623 NOTE PREPARED: Dec 29, 2021
BILL NUMBER: SB 189 BILL AMENDED:
SUBJECT: Pharmacist Contraceptive Prescriptions.
FIRST AUTHOR: Sen. Glick BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: This bill allows pharmacists who meet certain requirements to prescribe and
dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives. The bill
establishes requirements for pharmacists who prescribe and dispense contraceptives. It requires the Indiana
Board of Pharmacy to adopt rules. The bill also requires health plans to provide coverage for contraceptives
and certain services. It establishes an exception for nonprofit religious employers. It requires the Board to
issue an annual report to the Legislative Council.
Effective Date: July 1, 2022.
Explanation of State Expenditures: Summary - 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 minor. The bill would also require additional workload for the Professional Licensing Agency
(PLA), in consultation with the Department of Health, to adopt rules regarding pharmacist prescriptions for
contraceptives, as well as notify licensees of the new prescriptive authority and training requirements. The
Board of Pharmacy would also be required to report annually to the Legislative Council on pharmacist
contraceptive prescribing. These functions would likely be able to be accomplished within the Boards’
regularly scheduled business meetings under existing PLA staffing and resource levels.
The bill’s requirement that health plans cover prescription contraceptives may also 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
SB 189 1 members without cost-sharing. However, a 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
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 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%.
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: U.S. Supreme Court, Little Sisters of the Poor Saints Peter and Paul Home v.
Pennsylvania et al.: https://www.supremecourt.gov/opinions/19pdf/19-431_5i36.pdf.
Fiscal Analyst: Adam White, 317-234-1360; Karen Rossen, 317-234-2106.
SB 189 2