IndianaCost sharing; out-of-pocket expense credit.
What it does
Requires an insurer, an administrator, and a pharmacy benefit manager to apply the annual limitation on cost sharing set forth in the federal Patient Protection and Affordable Care Act under 42 U.S.C. 18022(c)(1) to prescription drugs that: (1) are covered under a health plan; (2) are life-saving or intended to manage chronic pain; and (3) do not have an approved generic version. Provides that an insurer, an administrator, and a pharmacy benefit manager may not directly or indirectly set, alter, implement, or condition the terms of health insurance coverage based in part or entirely on information about the availability or amount of financial or product assistance available for a prescription drug. Requires, before December 31 of each year, each insurer and administrator to certify to the insurance commissioner that the insurer or administrator has fully and completely complied with the cost sharing requirements during the previous calendar year.
More detail
Requires a health plan to credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to any health care provider for a medically necessary covered health care service if a claim for the health care service is not submitted to the health plan and the amount paid by the covered individual to the health care provider is less than the average discounted rate for the health care service paid to a health care provider in the health plan's network. Requires a health plan to: (1) establish a procedure by which a covered individual may claim a credit; and (2) identify documentation necessary to support a claim for a credit.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2025
- May 6Public Law 237Latest
- May 6Signed by the Governor Mike BraunBecame Law
- Apr 29Signed by the President of the SenateMajor
- Apr 24Signed by the President Pro TemporeMajor
- Apr 23Conference Committee Report 1: adopted by the Senate; Roll Call 493: yeas 45, nays 2
- Vote recorded HB 1604 - Carrasco. Result: pass.Upper
- Vote recorded HB 1604 - McGuire. Result: pass.Lower
- Apr 23Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 521: yeas 91, nays 0
- Apr 23Signed by the SpeakerMajor
- Apr 22CCR # 1 filed in the HouseMinor
- Apr 22CCR # 1 filed in the SenateMinor
- Apr 17Senate conferees appointed: Carrasco and Qaddoura
- Apr 17Senate advisors appointed: Randolph Lonnie M and Walker K
- Apr 15House dissented from Senate amendments
- Apr 15House conferees appointed: McGuire and Shackleford
- Apr 15Motion to dissent filedMinor
- Apr 15House advisors appointed: King, Barrett, Campbell and Dant Chesser
- Mar 26Returned to the House with amendmentsMinor
- Mar 25Senator Bohacek added as cosponsor
- Vote recorded HB 1604 - Carrasco - 3rd Reading. Result: pass.Upper
- Mar 25Third reading: passed; Roll Call 293: yeas 44, nays 3Passed Senate
- Mar 25Senator Rogers added as cosponsor
- Mar 25Senator Yoder added as cosponsor
- Mar 24Second reading: ordered engrossedMinor
- Mar 20Committee report: amend do pass, adoptedMinor
- Mar 20Senator Qaddoura added as cosponsor
- Mar 20Senator Ford J.D. added as cosponsor
- Mar 18Senator Hunley added as cosponsor
- Mar 13Senator Randolph added as cosponsor
- Mar 3First reading: referred to Committee on Insurance and Financial InstitutionsMinor
- Feb 18Referred to the SenateMinor
- Feb 17Third reading: passed; Roll Call 187: yeas 95, nays 0Passed House
- Vote recorded HB 1604 - McGuire - 3rd Reading. Result: pass.Lower
- Feb 17Senate sponsors: Senators Carrasco, Walker K, Freeman
- Feb 13Second reading: ordered engrossedMinor
- Feb 11Committee report: amend do pass, adoptedMinor
- Jan 27Representative Shackleford added as coauthor
- Jan 21Coauthored by Representatives King and Morris
- Jan 21Authored by Representative McGuire
- Jan 21First reading: referred to Committee on InsuranceIntroduced