COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:5011S.04T Bill No.:Truly Agreed To and Finally Passed SS for HB 2162 Subject:Office of Administration; Department of Corrections; Courts; Drugs and
Controlled Substances; Health, Public; Department of Health and Senior Services;
Pharmacy
Type:Original Date:May 24, 2022Bill Summary:This proposal modifies provisions relating to opioid addiction treatment.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 5011S.04T
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on All Federal
Funds $0$0$0
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2023FY 2024FY 2025Total Estimated Net
Effect on FTE 000
☐ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2023FY 2024FY 2025Local Government$0$0$0 L.R. No. 5011S.04T
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FISCAL ANALYSIS
ASSUMPTION
§195.206 – Addiction mitigation medication:
Officials from the Department of Commerce and Insurance and the Department of Health
and Senior Services each assume the proposal will have no fiscal impact on their respective
organizations. Oversight does not have any information to the contrary. Therefore, Oversight
will reflect a zero impact in the fiscal note for these agencies.
§196.1050 – Opioid Addiction Treatment and Recovery Fund:
Officials from the Attorney General’s Office, Department of Mental Health, Department of
Social Services, Department of Health and Senior Services, and the Department of Public
Safety each state this proposal would not fiscally impact their respective agencies.
In response to a previous version, officials from the Office of Administration
proposal would not have a fiscal impact on their agency.
Oversight notes that the above-mentioned agencies have stated the proposal would not have a
direct fiscal impact on their respective organizations. Oversight does not have any information to
the contrary. Therefore, Oversight will reflect a zero impact on the fiscal note.
Officials from the Office of the State Courts Administrator state there may be some impact
but there is no way to quantify that currently. The use of the Opioid Addiction Treatment and
Recovery Fund could potentially result in appropriations from the fund for the Judiciary.
Officials from the Department of Corrections (DOC) state the bill modifies provisions relating
to the opioid addiction treatment and recovery fund.
At intake, 46% of Missouri’s prison population reported a history of prescription drug, illicit
drug and/or alcohol use. Research indicates that approximately 58% of those confined in
prisons have a substance use disorder (Connolly, 2019). It is reasonable to assume offenders
likely under-reported their use at intake and that the true incidence is much closer to 58%.
Approximately 13,340 (23,000 x 58%) of the offenders incarcerated in Missouri prisons have a
substance use disorder. Methamphetamine is still the most common drug of choice among the
Missouri offender population; however, opioid use disorders are definitely on the rise and when
paired with alcohol use disorders are conservatively estimated to affect 4,002 (13,340 x 30%)
incarcerated offenders. L.R. No. 5011S.04T
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This legislation could have a positive impact on the Department of Corrections and could allow
for the expansion of programs and services. However, as this fund is dependent on monetary
settlements and appropriation by the General Assembly, it is unknown how much funding will be
appropriated to the DOC for use in treatment programming and prevention.
Oversight notes the following information is provided on the AGO’s website, “The Missouri
Attorney General’s Office recently announced a term sheet and settlement with several opioid
distributors (McKesson, Amerisource Bergen, and Cardinal Health), and Johnson & Johnson,
which could total just under half a billion dollars to be spent directly on opioid abatement and
treatment. This money will go to aid those suffering from addiction and provide needed
resources to treatment centers and other support systems across the state. With this settlement,
the Missouri Attorney General’s Office is working to fight addiction and save lives.” Also stated
on the AGO’s website “Under the term sheets that were distributed, the three distributors –
Amerisource Bergen, McKesson, Cardinal Health - collectively will pay up to $21 billion over 18
years. Johnson & Johnson will pay up to $5 billion over nine years with up to $3.7 billion paid
during the first three years. Formulas and payment structures are still being worked out, so the
exact monetary value that Missouri will receive is not final yet, although the settlement will mean
hundreds of millions for opioid abatement and treatment.”
Oversight assumes this part of the proposal simply expands the list of state agencies that can
receive monies from the Opioid Addiction Treatment and Recovery Fund (0705) (balance of
$9,735,606 at 4/30/2022) to also include the Department of Corrections and the Judiciary.
Oversight assumes the proposal does not create a direct fiscal impact to the state and would
simply allow more flexibility during the state’s appropriations process.
FISCAL IMPACT – State GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025$0$0$0FISCAL IMPACT – Local GovernmentFY 2023
(10 Mo.)
FY 2024FY 2025$0$0$0
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal. L.R. No. 5011S.04T
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FISCAL DESCRIPTION
Under this act, any licensed pharmacist may sell and dispense an addiction mitigation medication
under a physician protocol or a statewide standing order. A pharmacist who, acting in good faith
and with reasonable care, sells or dispenses the addiction mitigation medication and an
appropriate device to administer the drug, and the protocol physician, shall not be subject to any
criminal or civil liability or professional disciplinary action for prescribing or dispensing the
medication and any outcome resulting from the administration of the medication. A physician
issuing the statewide standing order shall likewise face no liability or professional discipline
relating to the order or administration of the medication. It shall be permissible for any person to
possess an addiction mitigation medication.
The proposed provides that, in addition to those departments that currently have access, the
Department of Corrections and the judiciary shall have access to the Opioid Addiction Treatment
and Recovery Fund to pay for opioid addiction treatment and prevention services and health care
and law enforcement costs related to opioid addiction treatment and prevention.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Attorney General’s Office
Department of Corrections
Department of Public Safety
Department of Health and Senior Services
Department of Mental Health
Department of Social Services
Department of Commerce and Insurance
Office of Administration
Office of the State Courts Administrator
Julie MorffRoss StropeDirectorAssistant DirectorMay 24, 2022May 24, 2022