Indiana 2025 Regular Session

Indiana Senate Bill SB0136 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. 136
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 27-1.
7	7	Synopsis: Disclosures related to prescription drugs. Beginning
8	8	January 1, 2026, requires a state employee health plan, a policy of
9	9	accident and sickness insurance, and a health maintenance organization
10	10	contract to provide to a covered individual the national average drug
11	11	acquisition cost of a generic drug on the written materials provided at
12	12	the point of sale. Provides that if an agreement between a health plan
13	13	and a pharmacy benefit manager that is entered into or renewed after
14	14	December 31, 2025, provides that less than 85% of the estimated
15	15	rebates will be deducted from the cost of prescription drugs before a
16	16	covered individual's cost sharing requirement is determined, the
17	17	pharmacy benefit manager must provide the policyholder with a notice
18	18	on an annual basis that includes: (1) an explanation of what a rebate is;
19	19	(2) an explanation of how rebates accrue to the health plan from the
20	20	manufacturer; and (3) the aggregate amount of rebates that accrued to
21	21	the health plan for prescription drugs dispensed under the
22	22	policyholder's health plan for the previous year.
23	23	Effective: July 1, 2025.
24	24	Bohacek
25	25	January 8, 2025, read first time and referred to Committee on Health and Provider
26	26	Services.
27	27	2025 IN 136—LS 6329/DI 154 Introduced
28	28	First Regular Session of the 124th General Assembly (2025)
29	29	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
30	30	Constitution) is being amended, the text of the existing provision will appear in this style type,
31	31	additions will appear in this style type, and deletions will appear in this style type.
32	32	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
33	33	provision adopted), the text of the new provision will appear in this style type. Also, the
34	34	word NEW will appear in that style type in the introductory clause of each SECTION that adds
35	35	a new provision to the Indiana Code or the Indiana Constitution.
36	36	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
37	37	between statutes enacted by the 2024 Regular Session of the General Assembly.
38	38	SENATE BILL No. 136
39	39	A BILL FOR AN ACT to amend the Indiana Code concerning
40	40	insurance.
41	41	Be it enacted by the General Assembly of the State of Indiana:
42	42	1 SECTION 1. IC 27-1-24.6 IS ADDED TO THE INDIANA CODE
43	43	2 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
44	44	3 JULY 1, 2025]:
45	45	4 Chapter 24.6. Disclosure of Negotiated Rate
46	46	5 Sec. 1. This chapter applies to generic drugs covered under a
47	47	6 health plan and dispensed or administered to a covered individual
48	48	7 after December 31, 2025.
49	49	8 Sec. 2. As used in this chapter, "covered individual" means an
50	50	9 individual who is entitled to coverage under a health plan.
51	51	10 Sec. 3. As used in this chapter, "generic drug" has the meaning
52	52	11 set forth in IC 27-1-24.5-4.
53	53	12 Sec. 4. As used in this chapter, "health plan" means the
54	54	13 following:
55	55	14 (1) A state employee health plan (as described in IC 5-10-8-7).
56	56	15 (2) A policy of accident and sickness insurance (as defined in
57	57	16 IC 27-8-5-1).
58	58	17 (3) An individual contract (as defined in IC 27-13-1-21) or a
59	59	2025 IN 136—LS 6329/DI 154 2
60	60	1 group contract (as defined in IC 27-13-1-16).
61	61	2 Sec. 5. As used in this chapter, "national average drug
62	62	3 acquisition cost" means the average price pharmacies pay for a
63	63	4 prescription drug. The term does not include a dispensing fee or a
64	64	5 professional fee.
65	65	6 Sec. 6. A health plan must provide the amount of the national
66	66	7 average drug acquisition cost for a generic drug on the written
67	67	8 materials provided to the covered individual at the point of sale of
68	68	9 the generic drug.
69	69	10 SECTION 2. IC 27-1-24.7 IS ADDED TO THE INDIANA CODE
70	70	11 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
71	71	12 JULY 1, 2025]:
72	72	13 Chapter 24.7. Disclosure of Rebates
73	73	14 Sec. 1. This chapter applies to an agreement between a
74	74	15 pharmacy benefit manager and a health plan regarding
75	75	16 prescription drugs that is entered into, renewed, or renegotiated
76	76	17 after December 31, 2025. This chapter does not apply to a health
77	77	18 plan, with point of sale rebates, if at least eighty-five percent (85%)
78	78	19 of the estimated rebates are deducted from the cost of prescription
79	79	20 drugs dispensed at a pharmacy or via mail order before a covered
80	80	21 individual's cost sharing requirement is determined.
81	81	22 Sec. 2. As used in this chapter, "covered individual" means an
82	82	23 individual who is entitled to coverage under a health plan.
83	83	24 Sec. 3. As used in this chapter, "health plan" means the
84	84	25 following:
85	85	26 (1) A state employee health plan (as described in IC 5-10-8-7).
86	86	27 (2) A policy of accident and sickness insurance (as defined in
87	87	28 IC 27-8-5-1).
88	88	29 (3) An individual contract (as defined in IC 27-13-1-21) and a
89	89	30 group contract (as defined in IC 27-13-1-16).
90	90	31 (4) Any other plan or program that provides payment,
91	91	32 reimbursement, or indemnification to a covered individual for
92	92	33 the cost of prescription drugs.
93	93	34 Sec. 4. As used in this chapter, "policyholder" means an
94	94	35 individual in whose name a health plan is held.
95	95	36 Sec. 5. As used in this chapter, "prescription drug" means a
96	96	37 controlled substance or a legend drug (as defined in
97	97	38 IC 16-18-2-199).
98	98	39 Sec. 6. (a) As used in this chapter, "rebate" means a discount or
99	99	40 other price concession that is:
100	100	41 (1) based on the use of a prescription drug; and
101	101	42 (2) paid by a manufacturer or a third party to a pharmacy
102	102	2025 IN 136—LS 6329/DI 154 3
103	103	1 benefit manager (as defined in IC 27-1-24.5-12), pharmacy
104	104	2 services administrative organization (as defined in
105	105	3 IC 27-1-24.5-15), or pharmacy (as defined in IC 27-1-24.5-11)
106	106	4 after a claim has been processed and paid at a pharmacy.
107	107	5 (b) The term includes an incentive and a disbursement.
108	108	6 Sec. 7. An agreement to which this chapter applies must contain
109	109	7 a contractual provision that requires the pharmacy benefit
110	110	8 manager to provide on an annual basis, not later than sixty (60)
111	111	9 days after the end of each policy year, a notice to a policyholder
112	112	10 that states the following:
113	113	11 (1) An explanation of what a rebate is.
114	114	12 (2) An explanation of how rebates accrue to a health plan
115	115	13 from a manufacturer.
116	116	14 (3) The aggregate amount of rebates for all prescription drugs
117	117	15 dispensed or administered to covered individuals on the
118	118	16 policyholder's health plan that accrued to the health plan
119	119	17 during the previous policy year. This information may not
120	120	18 include any information about an individual prescription
121	121	19 drug, including the name, manufacturer, quantity, or dosage
122	122	20 of a prescription drug.
123	123	21 The notice required by this section may be provided by first class
124	124	22 mail or electronic mail.
125	125	2025 IN 136—LS 6329/DI 154