FISCAL NOTE

Date Requested: March 04, 2022
Time Requested: 11:16 AM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
1978 Amendment HB4252
CBD Subject: Insurance


FUND(S):

PEIA Basic Insurance Fund

Sources of Revenue:

Special Fund

Legislation creates:

Increases Existing Expenses



Fiscal Note Summary


Effect this measure will have on costs and revenues of state government.


The purpose of this bill is to reduce costs for diabetics effective July 1, 2023. The bill proposes reducing the the cost-sharing a patient must pay for a covered prescription insulin drug to $35 for a 30-day supply of insulin, regardless of the amount or type of insulin needed. The bill limits member cost sharing to $100 per 30 days’ supply for devices used to cure, diagnose, mitigate, prevent, and treat diabetes or low blood sugar. Additionally, member cost sharing for an insulin pump may not exceed $250 and is limited to one insulin pump purchase every 2 years. PEIA offers diabetic members the benefit of a $25 and $50 copay for a 30-day or 90-day supply of insulin respectively. Accordingly, there would be no fiscal impact to PEIA for the proposed $35 cost for a thirty-day insulin supply. After members pay deductibles and coinsurance PEIA pays the cost remaining for devices and insulin pumps as defined in this bill. Limiting devices, such as continuous glucose monitors and supplies, to $100 per thirty-days’ supply would increase PEIA’s expenses by $56,000 annually. Limiting insulin pumps to $250 every 2 years would increase PEIA’s expenses by $121,000 annually. The proposed bill does not include insulin pump supplies with the definition of insulin pumps. PEIA notes that insulin pumps and corresponding supplies are billed under the same procedure codes. This will complicate administering the $250 limit to the pump exclusively if the bill passes. PEIA’s estimated expense increase for pumps includes unavoidable costs for related pump supplies as a clear division in the claims data does not exist.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2022
Increase/Decrease
(use"-")
2023
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 0 177,000
Personal Services 0 0 0
Current Expenses 0 0 177,000
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0


Explanation of above estimates (including long-range effect):


A study of plan year 2021 claims of similar types has been analyzed and trended to arrive at the estimated claims expense increase for plan year 2024.



Memorandum


The proposed bill does not include insulin pump supplies with the definition of insulin pumps. PEIA notes that insulin pumps and corresponding supplies are billed under the same procedure codes. This will complicate administering the $250 limit to the pump exclusively if the bill passes. PEIA’s estimated expense increase for pumps includes unavoidable costs for related pump supplies as a clear division in the claims data does not exist.



    Person submitting Fiscal Note: April Taylor
    Email Address: april.a.taylor@wv.gov