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 6804 NOTE PREPARED: Dec 29, 2023
BILL NUMBER: HB 1227 BILL AMENDED:
SUBJECT: Opioid Overdose Reversal Medication in Schools.
FIRST AUTHOR: Rep. Boy BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: GENERAL IMPACT: Local
DEDICATED
FEDERAL
Summary of Legislation: This bill sets forth certain requirements concerning naloxone nasal spray.
Effective Date: July 1, 2024.
Explanation of State Expenditures: The bill requires the State Health Commissioner or their designee to
issue a statewide standing order or prescription for naloxone nasal spray. This spray is currently available
over-the-counter and does not require a standing order or prescription. There is no workload impact for the
agency.
Explanation of State Revenues:
Explanation of Local Expenditures: Beginning in FY 2025, provisions in this bill require public schools
to partner with an opioid overdose prevention organization to assist the school in stocking and maintaining
at least 1 carton of naloxone nasal spray for every 500 students enrolled in the school. This is estimated to
increase statewide public school expenditures by $90,000 to stock the necessary amount of naloxone. Schools
may experience additional costs to provide storage for the medications and to refill the school’s naloxone
inventory as needed. Expenditures would decrease dependent on the amount of naloxone nasal spray schools
currently have in storage and to the extent that schools are able to partner with organizations offering free
naloxone.
Additional Information - Naloxone, also known by its brand name Narcan, is an antidote for opioid
overdoses. Narcan is produced by Emergent Biosolutions, who offers the drug at a public interest rate of $41
per carton. Each carton contains two doses of the drug and has a shelf life of three years.
HB 1227 1 Schools are currently authorized, but not required, to stock naloxone. Two types of naloxone are currently
available. Evzio is an auto-injector complete with voice-recorded instructions; Narcan Nasal Spray is an
intra-nasal device. Dependent on the amount of Narcan Nasal Spray schools currently have in stock, school
expenditures may be lower than projected.
U.S. high schools are also eligible to receive two free cartons of Narcan through Emergent Biosolutions’ Free
Goods Program. LSA assumed all eligible schools would participate in the Free Goods Program when
calculating the estimated total cost for public schools. Indiana schools may further decrease expenditures by
partnering with an opioid prevention organization. For example, schools who partner with Overdose Lifeline
may receive free naloxone from the organization’s Indiana School Naloxone Project which provided 75
emergency medical boxes containing naloxone to 56 school districts in 2022.
Explanation of Local Revenues:
State Agencies Affected:
Local Agencies Affected: Public schools.
Information Sources: Overdose Lifeline, 2022 Annual Report.
https://www.overdoselifeline.org/achievements/;
Emergent Biosolutions,
https://investors.emergentbiosolutions.com/news-releases/news-release-details/emergent-biosolutions-nar
canr-nasal-spray-launches-over-counter#:~:text=To%20that%20end%2C%20Emergent%20has,available
%20to%20at%2Drisk%20communities;
National Overdose Prevention Network, https://nopn.org/resources/free-narcan-nasal-spray-for-eligible-
schools;
Narcan Nasal Spray, FAQ.
https://rwjms.rutgers.edu/documents/departments/Psychiatry/Addiction%20Psychiatry/FAQ%20Shelf%2
0Life%20Extension%20and%20Updated%20Storage%20Conditions%20Final.pdf;
Food and Drug Administration,
https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-
spray#:~:text=Today%2C%20the%20U.S.%20Food%20and,for%20use%20without%20a%20prescription.
Fiscal Analyst: Kelan Fong, 317-232-9592.
HB 1227 2