Overview
In 2020, the Indiana legislature passed a law to mandate an all-payer claims database (APCD) that will include claims from Medicare, Medicaid or a Medicaid managed care organization, health maintenance organizations (HMOs), pharmacy benefit managers (PBMs), and other payers. The law also prohibits gag clauses in contracts with providers, PBMs, or health facilities. That is, the claims data may be disclosed to employers providing insurance coverage under such a contract.
The state also has taken price transparency initiatives to provide more protections against balance billing for non-emergency services, requiring cost-sharing parity for services provided by an out of network provider at an in-network facility unless several specific criteria are met. It also clearly defines and protects an individual’s right to receive a good faith estimate of the total price a practitioner will charge for providing a nonemergency health care service. The state also made strides in drug pricing transparency, enacting a law that prohibits insurers, HMOs, and other payers from limiting the ability of pharmacies and pharmacists to discuss more affordable alternative prescriptions with patients, as well as several transparency requirements regulating PBM contracts.
Additionally, Indiana has robust statutes to prevent anticompetitive practices in healthcare markets. In hospital merger review authority, Indiana requires notice to and approval by the Attorney General prior to the merger of any public benefit corporation, including nonprofit hospitals. Additionally, the state prohibits anticompetitive contract provisions in provider and insurer contracts, including most-favored nation clauses and gag clauses, and has passed laws requiring physician non-complete clauses to contain certain provisions to be enforceable.
In 2024, the state enacted legislation requiring health care entities to provide notice of certain mergers or acquisitions to office of the attorney general.
See below for an overview of existing Indiana state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 2/8/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1383 – Indiana
Introduced: 2022 Status: Inactive / Dead
Withdrawal from Medicare advantage networks. Provides that a hospital, physician, or physician group: (1) may not withdraw from a Medicare advantage network for any part of a calendar year after the calendar year has begun; …
HB 1393 – Indiana
Introduced: 2024 Status: In Process
Authorizes the managed care assessment fee to be assessed against specified insurers and administered by the office of the secretary of family and social services. Establishes the managed care assessment fee committee. Sets forth requirements …
HB 1393 – Indiana
Introduced: 2021 Status: Inactive / Dead
Pharmacy benefit managers. Prohibits the inclusion of certain provisions in a contract between a pharmacy benefit manager and an entity authorized to participate in the federal 340B Drug Pricing Program. Provides that a pharmacy benefit …
HB 1402 – Indiana
Introduced: 2021 Status: Enacted
All payer claims data base. Amends the definition of “health payer” to except some policies of accident and sickness insurance. Establishes requirements for the development and administration of the all payer claims data base. Establishes …
HB 1405 – Indiana
Introduced: 2021 Status: Enacted
Requires the legislative services agency to conduct a study of market concentration in Indiana in the health insurance industry, the hospital industry, and five other industries and to present the findings of the study to …
HB 1029 – Indiana
Introduced: 2019 Status: Enacted
Prescription drug pricing study committee. Urges the legislative council to assign to the interim study committee on public health, behavioral health, and human services the task of studying issues consumers face related to prescription drug …
HB 1421 – Indiana
Introduced: 2021 Status: Enacted
Provides that the state employee health plan statute does not prohibit the state personnel department from directly contracting with health care providers for health care services for state employees. Defines “health carrier” for purposes of …
Ind. Code § 12-15-1.3-18. Increase of reimbursement rate for services: Medicaid Waivers and Plan Amendments – Indiana
Introduced: Status: Enacted
The amount of the increase in the reimbursement rate described in subsection (b) for a state fiscal year beginning July 1, 2017, or thereafter is the reimbursement rate in effect as of June 30, 2017, …
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Ind. Code § 12-15-2-16.5. Assignment of rights to state: Medicaid — Eligibility – Indiana
Introduced: Status: Enacted
An individual who is applying for Medicaid or receiving Medicaid is considered to have automatically assigned to the state the individual’s rights, or the rights of any other person who is dependent upon the individual …
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Ind. Code § 12-15-29-0.5. Pharmacy benefit manager: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
As used in this chapter, “insurer” includes a pharmacy benefit manager.
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
FY 2019-2021 BUDGET
Indiana operates on a biennial budget. Agencies submit their budget requests to the governor in August and the governor submits his or her budget to the legislature in February. The budget is usually effective beginning July 1st. The budget for the FY 2019 to 2021 can be seen here.
KEY RESOURCES