COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:2277H.01I Bill No.:HB 1118 Subject:Drugs and Controlled Substances; Health Care Type:Original Date:February 21, 2025Bill Summary:This proposal creates provisions relating to abuse-deterrent opioid analgesic
drug products.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028
General
Will exceed
($101,767 to
$1,209,526)
Will exceed
($108,382 to
$1,288,145)
Will exceed
($115,427 to
$1,371,874)
Total Estimated Net
Effect on General
Revenue
Will exceed
($101,767 to
$1,209,526)
Will exceed
($108,382 to
$1,288,145)
Will exceed
($115,427 to
$1,371,874)
* The range represents the difference between a participant who would be on treatment for a
single month or twelve refills per year. Oversight
$250,000 annually.
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on Other State
Funds $0$0$0
Numbers within parentheses: () indicate costs or losses. L.R. No. 2277H.01I
Bill No. HB 1118
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February 21, 2025
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ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Federal $0$0$0Total Estimated Net
Effect on All Federal
Funds $0$0$0
* Income and expenses are estimated at $411,000 to $4.9 million annually and net to zero. The
range represents the difference between a participant who would be on treatment for a single
month or twelve refills per year.
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total 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 2026FY 2027FY 2028Local Government$0$0$0 L.R. No. 2277H.01I
Bill No. HB 1118
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February 21, 2025
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FISCAL ANALYSIS
ASSUMPTION
§ 208.176 and § 376.1239 - Abuse-deterrent opioid analgesic drug products
Officials from the Department of Social Services (DSS) state this legislation amends section
208.176 by adding language that states any prior authorization requirements for opioid analgesic
and any service denials made pursuant thereto shall not require use of opioid analgesic drug
products without abuse-deterrent properties before authorizing the use of abuse-deterrent opioid
analgesic drug products.
It also adds § 376.1239 stating an insurance carrier or health plan shall provide coverage on its
formulary, drug list, or other lists of similar constructs for at least one abuse-deterrent opioid
analgesic drug product per opioid analgesics active ingredient. This section also adds
information on cost-sharing for brand name and generic abuse-deterrent opioid analgesic drug
products and addresses prior authorization not being required.
This legislation applies to Chapter 208, which applies MO HealthNet, and to Chapter 376.
However, it addresses prescription drugs which are carved out of managed care and covered
under the MO Healthnet Fee-For-Service (FFS) Program. In addition, enrollees in the Managed
Care Program are not expected to pay cost-sharing amounts. As a result, this legislation would
have no fiscal impact on managed care operations or rates.
MHD FFS Pharmacy Program estimates the fiscal impact is $488,000 to $5.8 million annually.
The range represents the difference between a participant who would be on treatment for a single
month or twelve refills per year. A 6.5% inflation rate was applied to FY27 and FY28.
FY26 Total: $488,000 - $5,800,000 (GR: $101,767 – $1,209,526); (FED: $386,233 -
$4,590,474)
FY27 Total: $519,720 - $6,177,000 (GR: $108,382 – $1,288,145); (FED: $411,338 -
$4,888,855)
FY28 Total: $553,502 - $6,578,505 (GR: $115,427 – $1,371,874); (FED: $438,075 -
$5,206,631)
Oversight does not have information to the contrary and therefore, Oversight will reflect the
estimates as provided by the DSS.
Officials from the Department of Commerce and Insurance (DCI) state this proposal requires
insurers/health plans to have at least one abuse-deterrent opioid analgesic drug product for each
opioid analgesic active ingredient on its formulary and provisions related to the cost-sharing of
the drugs. This will have an Unknown impact on DCI: DCI would need to contract with a
resource with pharmaceutical knowledge to confirm compliance with these provisions. L.R. No. 2277H.01I
Bill No. HB 1118
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February 21, 2025
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Oversight does not have information to the contrary. Due to a lack of information, Oversight
will reflect the estimates as provided by DCI as “Unknown” costs. Oversight assumes the
unknown costs could exceed $250,000 annually.
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
Missouri Department of Transportation for the potential fiscal impact of this proposal.
Officials from the Department of Health and Senior Services, the Department of Public
Safety - Missouri Veterans Commission, the Missouri Consolidated Health Care Plan, the
Missouri Department of Conservation, the Missouri Department of Transportation
Oversight Division
organizations. Oversight does not have any information to the contrary. Therefore, Oversight
will reflect a zero impact in the fiscal note for these agencies.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other nursing homes and hospitals were requested to respond to this proposed
legislation but did not. A listing of political subdivisions included in the Missouri Legislative
Information System (MOLIS) database is available upon request.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUECosts – DSS, MHD (§ 208.176) FFS
Pharmacy Program refill costs p. 3
($101,767 to
$1,209,526)
($108,382 to
$1,288,145)
($115,427 to
$1,371,874)
Costs - DCI (§ 376.1239) Insurance
coverage of abuse-deterrent opioid
analgesic drug products p. 3-4(Unknown)(Unknown)(Unknown)
ESTIMATED NET EFFECT ON
GENERAL REVENUE
Will exceed
($101,767 to
$1,209,526)
Will exceed
($108,382 to
$1,288,145)
Will exceed
($115,427 to
$1,371,874) L.R. No. 2277H.01I
Bill No. HB 1118
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February 21, 2025
KP:LR:OD
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028FEDERAL FUNDSIncome - DSS, MHD (§ 208.176)
Reimbursement to FFS Pharmacy
Program for refill costs p. 3
$386,233 to
$4,590,474
$411,338 to
$4,888,855
$438,075 to
$5,206,631
Costs – DSS, MHD (§ 208.176) FFS
Pharmacy Program refill costs p. 3
($386,233 to
$4,590,474)
($411,338 to
$4,888,855)
($438,075 to
$5,206,631)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS$0$0$0
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028$0$0$0
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal.
FISCAL DESCRIPTION
This bill specifies that for MO HealthNet and for insurance carriers or health benefit plans, any
prior authorization requirements for opioid analgesic and any service denials made thereto do not
require the use of opioid analgesic drug products without abuse-deterrent properties before
authorizing the use of such drug products.
The bill also requires insurance carriers or health benefits plans to provide coverage on their
formulary or drug list at least one abuse-deterrent opioid analgesic drug product per opioid
analgesics active ingredient.
Cost-sharing for brand name or generic versions of this product are not to exceed the lowest cost-
sharing level applied to brand name or generic non-abuse deterrent opioid drugs covered under
the applicable health plan or policy. Additionally, an increase in patient cost-sharing or
disincentives for prescribers or dispensers is not allowed in order to achieve compliance with the
provisions of this bill. (§ 208.176 and § 376.1239) L.R. No. 2277H.01I
Bill No. HB 1118
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February 21, 2025
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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
Department of Commerce and Insurance
Department of Health and Senior Services
Department of Public Safety –
Missouri Highway Patrol
Missouri Veterans Commission
Department of Social Services
Missouri Consolidated Health Care Plan
Missouri Department of Conservation
Missouri Department of Transportation
Oversight Division
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 21, 2025February 21, 2025