Fiscal Note - SB 0422 - Allows Specified Licensed Psychologists to Prescribe Drugs
L.R. NO. 1707-01
BILL NO. SB 422
SUBJECT: Drugs and Controlled Substances: Pharmacy
TYPE: Original
DATE: March 17, 1997
FISCAL SUMMARY
ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
General Revenue (UNKNOWN) (UNKNOWN) (UNKNOWN)
Psychology ($3,307) ($3,382) ($3,459)
Pharmacy ($4,203) ($4,305) ($4,410)
Healing Arts ($3,307) ($3,382) ($3,459)
Total Estimated
Net Effect on All
State Funds (UNKNOWN) (UNKNOWN) (UNKNOWN)
ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
Medicaid $0 $0 $0
Total Estimated
Net Effect on All
Federal Funds $0 $0 $0
ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED FY 1998 FY 1999 FY 2000
Local Government $0 $0 $0
FISCAL ANALYSIS
ASSUMPTION
Officials from the Office of Prosecution Services, the Office of
Administration, the State Public Defender, the Office of State Courts
Administrator, the Department of Transportation, the Department of Public
Safety - Missouri State Highway Patrol, the Office of Attorney General, the
Department of Mental Health, and the Department of Conservation assume this
proposal would not fiscally impact their agencies.
Missouri Consolidated Health Care Plan (HCP) officials state there will be
probably be some fiscal impact as a result of this proposal simply because a
new set providers will have the ability to write prescriptions. HCP states
however it may not be an extensive cost under the assumption that the
majority of the individuals who would receive medication from a psychologist
would obtain it anyway through a referral to a physician.
Officials from the Department of Health (DOH) state there are 1,771 licensed
psychologists in the state currently. DOH states the State Committee of
Psychologists has stated licensed psychologists may wish to become trained
and licensed to prescribe. DOH estimates that one-third (584) of these
licensed psychologists would become trained and licensed to prescribe
medications including controlled substances medications. DOH assumes these
individuals would register with the Missouri Bureau of Narcotics and
Dangerous Drugs and the federal Drug Enforcement Administration. DOH
estimates the $30 registration fee would generate $17,520 annually for the
General Revenue Fund.
Department of Economic Development - Division of Professional Registration
(DPR) officials assume that the Committee of Psychologists, the Board of
Healing Arts, and the Board of Pharmacy would meet jointly to promulgate
rules establishing a formulary of drugs which would be prescribed by
psychologists in systemic pathopsychology. DPR states they would also be
required to meet annually thereafter to update the list. DPR estimates that
four members from each board will have two meetings for two days in Jefferson
City to establish the list and to maintain it. DPR also assumes that the
members would arrive the evening before the meeting. Also, one staff member
from each board would attend. DPR assumes that a list of psychologists
authorized to prescribe drugs and the list of drugs that they could prescribe
would be sent to 1,400 pharmacies twice per year. This expense would be
incurred by the Board of Pharmacy. DPR further states the American
Psychological Association estimates that there would be a national
examination available by the time the applicants would complete the course
study requirements; therefore, it is assumed that a national examination
would be utilized by the State Committee of Psychologists. However, if no
examination is in place up the applicant's completion of the required course
studies, additional personal services and expense and equipment funding would
be needed to develop an examination. DPR further assumes that the
examination fee would be paid directly to the testing service by the exam
applicant.
Officials from the Department of Social Services (DOS) state the Missouri
Medicaid program is required by Section 208.152, RSMo to make payments for
drugs and medicines only when prescribed by a licensed physician, dentist, or
podiatrist. DOS assumes that currently Medicaid recipients receive any
needed medications through prescriptions written by physicians or
psychiatrists. By increasing the number of providers able to prescribe
drugs, DOS states the number of prescriptions would generally increase.
This would be due to the greater access of Medicaid recipients to providers
able to write prescriptions. DOS states it is not possible to estimate the
amount of fiscal impact for increased prescriptions at this time. DOS
assumes the proposal would require the State Committee of Psychologists, the
State Board of Healing Arts, and the State Board of Pharmacy to establish a
formulary of drugs which may be prescribed by psychologists. In addition,
DOS assumes psychologists must complete a certain level of training and apply
to the State Committee of Psychologists for authority to prescribe drugs.
DOS has no historical data or assumptions to quantify the number of
psychologists that would seek certification to prescribe drugs, the types of
drugs psychologists would be able to prescribe based on the unestablished
formulary, the number of drugs psychologists would prescribe, or the number
of psychologists the state committee would certify for prescribing drugs.
DOS further states that while they cannot arrive at an actual dollar increase
to Medicaid, DOS believes there would be an impact exceeding $100,000. DOS
states the current pharmacy program reimburses 10 million prescriptions per
year. DOS assumes that if the proposal increases the number of prescriptions
by one percent, the cost of dispensing those prescriptions alone would be an
additional $409,000. In addition, DOS assumes that internal administration
costs would increase to monitor a new type of provider that would be able to
prescribe drugs.
FISCAL IMPACT - State Government FY 1998 FY 1999 FY 2000
(10 Mo.)
GENERAL REVENUE FUND
Income - Department of Health
Registration fees $17,520 $17,520 $17,520
Costs - Department of Social Services
Increased services* (UNKNOWN) (UNKNOWN) (UNKNOWN)
ESTIMATED NET EFFECT ON
GENERAL REVENUE FUND (UNKNOWN) (UNKNOWN) (UNKNOWN)
*DOS assumes costs greater than $100,000
PSYCHOLOGY FUND
Costs - State Committee of Psychologists
Meeting expenses ($3,307) ($3,382) ($3,459)
ESTIMATED NET EFFECT ON
PSYCHOLOGY FUND ($3,307) ($3,382) ($3,459)
PHARMACY FUND
Costs - Board of Pharmacy
Meeting expenses ($4,203) ($4,305) ($4,410)
ESTIMATED NET EFFECT ON
PHARMACY FUND ($4,203) ($4,305) ($4,410)
HEALING ARTS FUND
Costs - Board of Healing Arts
Meeting expenses ($3,307) ($3,382) ($3,459)
ESTIMATED NET EFFECT ON
HEALING ARTS FUND ($3,307) ($3,382) ($3,459)
FEDERAL FUNDS
Income - Department of Social Services
Medicaid reimbursements UNKNOWN UNKNOWN UNKNOWN
Costs - Department of Social Services
Increased services (UNKNOWN) (UNKNOWN) (UNKNOWN)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS $0 $0 $0
FISCAL IMPACT - Local Government FY 1998 FY 1999 FY 2000
(10 Mo.)
$0 $0 $0
FISCAL IMPACT - Small Business
Small businesses would be expected to be fiscally impacted to the extent they
would incur additional costs for licensure and additional revenue for new
services due to the requirements of this proposal.
DESCRIPTION
This proposal would allow licensed psychologists approved by the State
Committee of Psychologists to be certified to prescribe drugs and other
medications necessary in the treatment of mental health disorders. When
applying for this certification a licensed psychologist would provide
evidence of completion of a pharmacology course, with at least 100 hours of
approved clinical training and at least 200 hours of independent course study
in the assessment of the need for and the prescription of drugs in the
treatment of persons with psychological problems and emotional and mental
disorders and illnesses. The State Committee of Psychologists would be
required to provide to the State Board of Pharmacy a list of names of all
those licensed psychologists certified to prescribe medication. The State
Committee of Psychologists, the State Board of Registration for the Healing
Arts and the Board of Pharmacy would promulgate rules establishing a
formulary of drugs which may be prescribed by psychologists.
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 Economic Development
Division of Professional Registration
Office of Prosecution Services
Office of Attorney General
Office of State Courts Administrator
State Public Defender
Department of Health
Department of Mental Health
Department of Social Services
Missouri Consolidated Health Care Plan
Department of Conservation
Department of Transportation
Department of Public Safety
Missouri State Highway Patrol
Office of Administration
This Fiscal Note is not an official copy and should not be quoted or cited.