Indiana 2025 Regular Session

Indiana Senate Bill SB0133 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	SENATE BILL No. 133
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 5-10-8-18.5; IC 27-1-24.5; IC 27-8-5-32;
7	7	IC 27-13-7-23.5.
8	8	Synopsis: Restriction on co-pay accumulators. Provides that under
9	9	certain circumstances, the administrator of a state employee health plan
10	10	shall include any amount paid by a covered individual or another
11	11	person on behalf of the covered individual for a prescription drug when
12	12	calculating a covered individual's overall contribution to an
13	13	out-of-pocket maximum or cost sharing requirement under the covered
14	14	individual's state employee health plan. Provides that under certain
15	15	circumstances, a pharmacy benefit manager shall include any amount
16	16	paid by a covered individual or another person on behalf of the covered
17	17	individual for a prescription drug when calculating a covered
18	18	individual's overall contribution to an out-of-pocket maximum or cost
19	19	sharing requirement under the covered individual's health plan.
20	20	Provides that under certain circumstances, an insurer that issues a
21	21	policy of accident and sickness insurance shall include any amount
22	22	paid by an insured or another person on behalf of the insured for a
23	23	prescription drug when calculating an insured's overall contribution to
24	24	an out-of-pocket maximum or cost sharing requirement under the
25	25	insured's policy of accident and sickness insurance. Provides that under
26	26	certain circumstances, a health maintenance organization shall include
27	27	any amount paid by an enrollee or another person on behalf of the
28	28	enrollee for a prescription drug when calculating an enrollee's overall
29	29	contribution to an out-of-pocket maximum or cost sharing requirement
30	30	under the enrollee's individual or group contract.
31	31	Effective: July 1, 2025.
32	32	Ford J.D.
33	33	January 8, 2025, read first time and referred to Committee on Health and Provider
34	34	Services.
35	35	2025 IN 133—LS 6462/DI 154 Introduced
36	36	First Regular Session of the 124th General Assembly (2025)
37	37	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
38	38	Constitution) is being amended, the text of the existing provision will appear in this style type,
39	39	additions will appear in this style type, and deletions will appear in this style type.
40	40	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
41	41	provision adopted), the text of the new provision will appear in this style type. Also, the
42	42	word NEW will appear in that style type in the introductory clause of each SECTION that adds
43	43	a new provision to the Indiana Code or the Indiana Constitution.
44	44	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
45	45	between statutes enacted by the 2024 Regular Session of the General Assembly.
46	46	SENATE BILL No. 133
47	47	A BILL FOR AN ACT to amend the Indiana Code concerning
48	48	insurance.
49	49	Be it enacted by the General Assembly of the State of Indiana:
50	50	1 SECTION 1. IC 5-10-8-18.5 IS ADDED TO THE INDIANA CODE
51	51	2 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
52	52	3 1, 2025]: Sec. 18.5. (a) This section applies to a state employee
53	53	4 health plan that is established, entered into, amended, or renewed
54	54	5 after June 30, 2025.
55	55	6 (b) This section does not apply to an originating brand name
56	56	7 prescription drug for which a generic alternative exists, unless the
57	57	8 covered individual has obtained access to the originating brand
58	58	9 name drug through:
59	59	10 (1) prior authorization;
60	60	11 (2) a step therapy protocol; or
61	61	12 (3) the administrator's exceptions or appeals process.
62	62	13 (c) As used in this section, "administrator" has the meaning set
63	63	14 forth in section 11(a) of this chapter.
64	64	15 (d) As used in this section, "covered individual" means an
65	65	16 individual entitled to coverage under a state employee health plan.
66	66	17 (e) As used in this section, "generic alternative" means a drug
67	67	2025 IN 133—LS 6462/DI 154 2
68	68	1 that is:
69	69	2 (1) designated to be therapeutically equivalent to an
70	70	3 originating brand name prescription drug by the federal Food
71	71	4 and Drug Administration; and
72	72	5 (2) nationally available.
73	73	6 (f) As used in this section, "state employee health plan" means
74	74	7 the following:
75	75	8 (1) A self-insurance program established under section 7(b) of
76	76	9 this chapter.
77	77	10 (2) A contract for prepaid health care services entered into
78	78	11 under section 7(c) of this chapter.
79	79	12 (g) When calculating a covered individual's overall contribution
80	80	13 to an out-of-pocket maximum or cost sharing requirement under
81	81	14 the covered individual's state employee health plan, the
82	82	15 administrator shall include any amount paid by the covered
83	83	16 individual or another person on behalf of the covered individual
84	84	17 for a prescription drug.
85	85	18 SECTION 2. IC 27-1-24.5-3.7 IS ADDED TO THE INDIANA
86	86	19 CODE AS A NEW SECTION TO READ AS FOLLOWS
87	87	20 [EFFECTIVE JULY 1, 2025]: Sec. 3.7. As used in this chapter,
88	88	21 "generic alternative" means a drug that is:
89	89	22 (1) designated to be therapeutically equivalent to an
90	90	23 originating brand name prescription drug by the federal Food
91	91	24 and Drug Administration; and
92	92	25 (2) nationally available.
93	93	26 SECTION 3. IC 27-1-24.5-27.7 IS ADDED TO THE INDIANA
94	94	27 CODE AS A NEW SECTION TO READ AS FOLLOWS
95	95	28 [EFFECTIVE JULY 1, 2025]: Sec. 27.7. (a) This section applies to a
96	96	29 health plan entered into or renewed after June 30, 2025.
97	97	30 (b) This section does not apply to an originating brand name
98	98	31 prescription drug for which a generic alternative exists, unless the
99	99	32 covered individual has obtained access to the originating brand
100	100	33 name drug through:
101	101	34 (1) prior authorization;
102	102	35 (2) a step therapy protocol; or
103	103	36 (3) the pharmacy benefit manager's exceptions or appeals
104	104	37 process.
105	105	38 (c) When calculating a covered individual's overall contribution
106	106	39 to an out-of-pocket maximum or cost sharing requirement under
107	107	40 the covered individual's health plan, a pharmacy benefit manager
108	108	41 shall include any amount paid by the covered individual or another
109	109	42 person on behalf of the covered individual for a prescription drug.
110	110	2025 IN 133—LS 6462/DI 154 3
111	111	1 SECTION 4. IC 27-8-5-32 IS ADDED TO THE INDIANA CODE
112	112	2 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
113	113	3 1, 2025]: Sec. 32. (a) This section applies to a policy of accident and
114	114	4 sickness insurance that is issued, entered into, amended, or
115	115	5 renewed after June 30, 2025.
116	116	6 (b) This section does not apply to an originating brand name
117	117	7 prescription drug for which a generic alternative exists, unless the
118	118	8 covered individual has obtained access to the originating brand
119	119	9 name drug through:
120	120	10 (1) prior authorization;
121	121	11 (2) a step therapy protocol; or
122	122	12 (3) the insurer's exceptions or appeals process.
123	123	13 (c) As used in this section, "generic alternative" means a drug
124	124	14 that is:
125	125	15 (1) designated to be therapeutically equivalent to an
126	126	16 originating brand name prescription drug by the federal Food
127	127	17 and Drug Administration; and
128	128	18 (2) nationally available.
129	129	19 (d) As used in this section, "insured" means an individual
130	130	20 entitled to coverage under a policy of accident and sickness
131	131	21 insurance.
132	132	22 (e) As used in this section, "policy of accident and sickness
133	133	23 insurance" has the meaning set forth in IC 27-8-5-1.
134	134	24 (f) When calculating an insured's overall contribution to an
135	135	25 out-of-pocket maximum or cost sharing requirement under the
136	136	26 insured's policy of accident and sickness insurance, an insurer shall
137	137	27 include any amount paid by the insured or another person on
138	138	28 behalf of the insured for a prescription drug.
139	139	29 SECTION 5. IC 27-13-7-23.5 IS ADDED TO THE INDIANA
140	140	30 CODE AS A NEW SECTION TO READ AS FOLLOWS
141	141	31 [EFFECTIVE JULY 1, 2025]: Sec. 23.5. (a) This section applies to an
142	142	32 individual contract and a group contract that is entered into,
143	143	33 delivered, amended, or renewed after June 30, 2025.
144	144	34 (b) This section does not apply to an originating brand name
145	145	35 prescription drug for which a generic alternative exists, unless the
146	146	36 covered individual has obtained access to the originating brand
147	147	37 name prescription drug through:
148	148	38 (1) prior authorization;
149	149	39 (2) a step therapy protocol; or
150	150	40 (3) the health maintenance organization's exceptions or
151	151	41 appeals process.
152	152	42 (c) As used in this section, "generic alternative" means a drug
153	153	2025 IN 133—LS 6462/DI 154 4
154	154	1 that is:
155	155	2 (1) designated to be therapeutically equivalent to an
156	156	3 originating brand name prescription drug by the federal Food
157	157	4 and Drug Administration; and
158	158	5 (2) nationally available.
159	159	6 (d) When calculating an enrollee's overall contribution to an
160	160	7 out-of-pocket maximum or cost sharing requirement under the
161	161	8 enrollee's individual or group contract, a health maintenance
162	162	9 organization shall include any amount paid by the enrollee or
163	163	10 another person on behalf of the enrollee for a prescription drug.
164	164	2025 IN 133—LS 6462/DI 154