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