LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 7197 NOTE PREPARED: Jan 3, 2025
BILL NUMBER: HB 1358 BILL AMENDED:
SUBJECT: Coverage of Prescription Pain Medications.
FIRST AUTHOR: Rep. Porter BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: This bill has the following provisions:
1) It provides that the Office of the Secretary of Family and Social Services (FSSA) may not place greater
coverage restrictions on a non-opioid drug prescribed for the treatment or management of pain than the
coverage restrictions placed on an opioid drug prescribed to treat or manage pain with respect to the
Medicaid program or the Children's Health Insurance Program (CHIP).
2) It provides that a policy of accident and sickness insurance and a health maintenance organization contract
may not place greater coverage restrictions on a non-opioid drug prescribed for the treatment or management
of pain than the coverage restrictions placed on an opioid drug prescribed to treat or manage pain.
Effective Date: July 1, 2025.
Explanation of State Expenditures: If the bill’s prohibition on restrictions for non-opioid drugs prescribed
for the treatment or management of pain increases utilization of such treatments, related costs to the state
Medicaid and CHIP plans could increase. However, the bill does not require a plan to cover any specific
drugs or treatment therapies.
Medicaid and the CHIP are jointly funded between the state and federal governments. The state share of costs
for most Medicaid medical services for FFY 2025 is 35%, 10% for the age 19 to 64 expansion population
within the Healthy Indiana Plan (HIP), and 25% for CHIP. The state share of most Medicaid and CHIP
expenditures is paid from state General Fund appropriations, and state dedicated funds primarily cover HIP
costs. An increase in premium costs for additional procedures incurred by the state health plans may be
mitigated with adjustments to other benefits, or through the division of premium costs between the state and
state employees.
Explanation of State Revenues:
Explanation of Local Expenditures: Local entities providing a policy of accident and sickness, or a Health
HB 1358 1 Maintenance Organization may have increased premiums to cover any increase to prescription costs. Any
change or increase in costs or premiums may be mitigated with adjustments to other benefits or to employee
compensation packages.
Explanation of Local Revenues:
State Agencies Affected: Office of the Secretary of Family and Social Services.
Local Agencies Affected: Local entities providing health care insurance.
Information Sources:
Fiscal Analyst: Allison Leeuw, 317-234-9465.
HB 1358 2