Fabio
112 lines
8.4 KiB
Markdown
112 lines
8.4 KiB
Markdown
---
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type: "Bill"
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title: "Cost sharing; out-of-pocket expense credit."
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description: "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. 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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jurisdiction: "us/states/in"
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legislature: "Indiana General Assembly"
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session: "2025"
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identifier: "HB 1604"
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citation: "Indiana HB 1604 (2025)"
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classification: ["bill"]
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subjects: ["HEALTH; Billing and Costs", "INSURANCE; Health Insurance"]
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status: "enacted"
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primary_sponsors: ["Aaron Freeman", "Cyndi Carrasco", "Julie McGuire", "Kyle Walker"]
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version_count: 4
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action_count: 36
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vote_count: 4
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first_action: "2025-01-21"
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last_action: "2025-05-06"
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source: "openstates"
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source_identifier: "ocd-bill/4d7fdfdb-101a-4365-9390-d261ff7ec9c1"
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source_url: "https://api.iga.in.gov/2025/bills/hb1604"
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source_hash: "8179efb984aa2920529868acd4511c4f5e2b5fec6ce85ee9aaa5da68f6c1d2eb"
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vintage: "2026-07-01"
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source_snapshot: "https://data.openstates.org/daily/2026-07-01/public.pgdump"
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retrieved_at: "2026-07-06"
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confidence: "reported"
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tags: ["legislation", "bill", "us-in"]
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---
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# Indiana HB 1604 (2025) — Cost sharing; out-of-pocket expense credit.
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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. 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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## Version chain
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The bill's text revisions, in order — the diff chain from filing to enrollment.
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1. **Enrolled House Bill (H)** (committee substitute) — [source](https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1604/HB1604.04.ENRS.pdf)
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2. **House Bill (H)** (committee substitute) — [source](https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1604/HB1604.03.COMS.pdf)
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3. **House Bill (S)** (committee substitute) — [source](https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1604/HB1604.02.COMH.pdf)
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4. **Introduced House Bill (H)** (committee substitute) — [source](https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1604/HB1604.01.INTR.pdf)
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## Votes
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- HB 1604 - McGuire — **91–0** (pass) · lower
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- HB 1604 - Carrasco — **45–2** (pass) · upper
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- HB 1604 - Carrasco - 3rd Reading — **44–3** (pass) · upper
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- HB 1604 - McGuire - 3rd Reading — **95–0** (pass) · lower
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## Sponsors
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- Aaron Freeman — primary (person)
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- Cyndi Carrasco — primary (person)
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- Julie McGuire — primary (person)
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- Kyle Walker — primary (person)
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- Andrea Hunley — cosponsor (person)
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- Fady Qaddoura — cosponsor (person)
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- J.D. Ford — cosponsor (person)
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- Joanna King — coauthor (person)
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- Linda Rogers — cosponsor (person)
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- Lonnie Randolph — cosponsor (person)
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- Mike Bohacek — cosponsor (person)
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- Robert Morris — coauthor (person)
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- Robin Shackleford — coauthor (person)
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- Shelli Yoder — cosponsor (person)
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## Timeline
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The legislative action history — every referral, reading, and vote.
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- **2025-01-21** First reading: referred to Committee on Insurance `reading-1, referral-committee`
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- **2025-01-21** Authored by Representative McGuire
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- **2025-01-21** Coauthored by Representatives King and Morris
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- **2025-01-27** Representative Shackleford added as coauthor
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- **2025-02-11** Committee report: amend do pass, adopted `committee-passage`
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- **2025-02-13** Second reading: ordered engrossed `reading-2`
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- **2025-02-17** Senate sponsors: Senators Carrasco, Walker K, Freeman
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- **2025-02-17** Third reading: passed; Roll Call 187: yeas 95, nays 0 `passage, reading-3, reading-3`
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- **2025-02-18** Referred to the Senate `referral`
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- **2025-03-03** First reading: referred to Committee on Insurance and Financial Institutions `reading-1, referral-committee`
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- **2025-03-13** Senator Randolph added as cosponsor
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- **2025-03-18** Senator Hunley added as cosponsor
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- **2025-03-20** Senator Ford J.D. added as cosponsor
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- **2025-03-20** Senator Qaddoura added as cosponsor
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- **2025-03-20** Committee report: amend do pass, adopted `committee-passage`
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- **2025-03-24** Second reading: ordered engrossed `reading-2`
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- **2025-03-25** Senator Yoder added as cosponsor
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- **2025-03-26** Returned to the House with amendments `receipt`
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- **2025-03-25** Senator Rogers added as cosponsor
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- **2025-03-25** Third reading: passed; Roll Call 293: yeas 44, nays 3 `passage, reading-3, reading-3`
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- **2025-03-25** Senator Bohacek added as cosponsor
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- **2025-04-15** House advisors appointed: King, Barrett, Campbell and Dant Chesser
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- **2025-04-15** Motion to dissent filed `filing`
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- **2025-04-15** House conferees appointed: McGuire and Shackleford
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- **2025-04-15** House dissented from Senate amendments
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- **2025-04-17** Senate advisors appointed: Randolph Lonnie M and Walker K
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- **2025-04-17** Senate conferees appointed: Carrasco and Qaddoura
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- **2025-04-22** CCR # 1 filed in the Senate `filing`
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- **2025-04-22** CCR # 1 filed in the House `filing`
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- **2025-04-23** Signed by the Speaker `passage`
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- **2025-04-23** Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 521: yeas 91, nays 0
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- **2025-04-23** Conference Committee Report 1: adopted by the Senate; Roll Call 493: yeas 45, nays 2
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- **2025-04-24** Signed by the President Pro Tempore `passage`
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- **2025-05-06** Signed by the Governor `executive-signature`
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- **2025-04-29** Signed by the President of the Senate `passage`
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- **2025-05-06** Public Law 237 `became-law`
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## Source
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OpenStates / OpenCivicData bulk snapshot [2026-07-01](https://data.openstates.org/daily/2026-07-01/public.pgdump); origin `ocd-bill/4d7fdfdb-101a-4365-9390-d261ff7ec9c1`. Confidence: reported (aggregated from official Indiana legislature records).
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