Bill > HB1252

This bill aims to regulate cost sharing and prescription drug pricing in health insurance plans in Indiana, with key provisions focused on implementing the annual cost sharing limitation from the Affordable Care Act. The bill defines several important terms, including "cost sharing" as any copayment, coinsurance, deductible, or similar charge required from a covered individual for health care services. It requires pharmacy benefit managers, insurers, and administrators to apply the federal limitation on cost sharing to all health care services and mandates that when calculating a patient's cost sharing contribution, they must include amounts paid both by the individual and on their behalf by other parties. The bill also prohibits these entities from setting or altering health plan coverage terms based on information about financial assistance available for prescription drugs. Additionally, the legislation requires insurers and administrators to certify their compliance with these requirements to the insurance commissioner annually by December 31, with the certification to be signed by the organization's chief executive or financial officer. The provisions will apply to health plans issued, delivered, amended, or renewed after December 31, 2025, and include specific considerations for health savings account eligibility to ensure patients are not inadvertently disqualified from these accounts.

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https://iga.in.gov/legislative/2025/bills/house/1252/details