COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:1047H.01I Bill No.:HB 79 Subject:Insurance - Health; Health Care; Drugs and Controlled Substances Type:Original Date:January 26, 2025Bill Summary:This proposal creates provisions relating to cost-sharing under health benefit
plans.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on General
Revenue $0$0$0
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028
State Road Fund
$0 to
(Unknown, could
exceed $250,000)
$0 to
(Unknown, could
exceed $250,000)
$0 to
(Unknown, could
exceed $250,000)
Total Estimated Net
Effect on Other State
Funds
$0 to
(Unknown, could
exceed $250,000)
$0 to
(Unknown, could
exceed $250,000)
$0 to
(Unknown, could
exceed $250,000)
*Oversight assumes this proposal could result in a cost to the MoDOT-MSHP and local medical
plans that could potentially be passed on to members.
Numbers within parentheses: () indicate costs or losses. L.R. No. 1047H.01I
Bill No. HB 79
Page 2 of
January 26, 2025
KC:LR:OD
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on All Federal
Funds $0$0$0
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 2028
Local Government
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
*Oversight assumes this proposal could result in a cost to the MoDOT-MSHP and local medical
plans that could potentially be passed on to members. L.R. No. 1047H.01I
Bill No. HB 79
Page 3 of
January 26, 2025
KC:LR:OD
FISCAL ANALYSIS
ASSUMPTION
376.448- Enrollee’s Cost Sharing
Officials from the Missouri Department of Transportation state this bill may increase costs
for PBMs, which will likely pass on costs to the MoDOT-MSHP medical plan. This would have
an unknown negative impact to the State Road Fund.
In response to a similar proposal from last year (SB 844), MoDOT assumed the direct impact to
the Plan is equal to the total of $2,287,835. However, the members will also be impacted due to
the current plan design. Member’s will be required to pay 30% of the total cost of the drug and
this amount will apply to the member’s annual out of pocket, therefore members will move
through the benefit phases quicker. MoDOT is unable to identify the full impact based on how
many members would meet their annual out of pocket. MoDOT worked with a total of 296
members throughout 2023 and there’s a potential that all these members could meet their annual
max out of pocket mid-year and the plan cost may increase above the $2,287,835.
Since it is unknown if this proposal will result in a cost to the medical plan that could pass on to
members, Oversight will range the fiscal impact as $0 to Unknown, greater than $250,000 to the
State Road Fund. Oversight assumes this proposal could have a fiscal impact on local political
subdivisions.
Officials from the Missouri Consolidated Health Care PlanDepartment of Commerce
and Insurance, the Department of Social Services, the Missouri Department of
Conservation, the Oversight DivisionCity of O’Fallon and Kansas City each assume the
proposal will have no fiscal impact on their respective organizations.
Oversight notes that the above mentioned agencies have stated the proposal would not have a
direct fiscal impact on their organization. Oversight does not have any information to the
contrary. Therefore, Oversight will reflect a zero impact on the fiscal note for this agencies.
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. L.R. No. 1047H.01I
Bill No. HB 79
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January 26, 2025
KC:LR:OD
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028STATE ROAD FUND
Cost – MoDOT §376.448
Enrollee’s Cost Sharing
$0 to
(Unknown,
could exceed
$250,000)
$0 to
(Unknown,
could exceed
$250,000)
$0 to
(Unknown,
could exceed
$250,000)
ESTIMATED NET EFFECT TO
THE STATE ROAD FUND
$0 to
(Unknown,
could exceed
$250,000)
$0 to
(Unknown,
could exceed
$250,000)
$0 to
(Unknown,
could exceed
$250,000)
*Oversight assumes this proposal could result in a cost to the MoDOT-MSHP and local medical
plans that could potentially be passed on to members.
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028LOCAL POLITICAL
SUBDIVISIONS
Cost – §376.448
Enrollee’s Cost Sharing
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO
LOCAL POLITICAL
SUBDIVISIONS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
*Oversight assumes this proposal could result in a cost to the MoDOT-MSHP and local medical
plans that could potentially be passed on to members.
FISCAL IMPACT – Small Business
A direct fiscal impact to health carrier or pharmacy benefits manager could be expected as a
result of this proposal.
FISCAL DESCRIPTION
This act provides that when calculating an enrollee's overall contribution to an out-of-pocket max
or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits
manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee for any
medication for which a generic substitute is not available. L.R. No. 1047H.01I
Bill No. HB 79
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January 26, 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 Public Safety - Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation
Missouri Department of Transportation
Missouri Consolidated Health Care Plan
Oversight Division
Kansas City
City of O’Fallon
Julie MorffJessica HarrisDirectorAssistant DirectorJanuary 26, 2025January 26, 2025