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 1001 – Indiana
Introduced: 2019 Status: Enacted
State budget. Appropriates money for capital expenditures, the operation of the state, K-12 and higher education, the delivery of Medicaid and other services, and various other distributions and purposes. Renames the build Indiana fund the …
HB 1003 – Indiana
Introduced: 2023 Status: Inactive / Dead
Health matters. Allows a credit against the state tax liability of an employer with fewer than 50 employees if the employer has adopted a health reimbursement arrangement in lieu of a traditional employer provided health …
HB 1004 – Indiana
Introduced: 2023 Status: Enacted
Establishes the health care cost oversight task force and sets forth duties of the task force. Provides a credit against state tax liability to certain physicians who have an ownership interest in a physician practice …
HB 1004 – Indiana
Introduced: 2020 Status: Enacted
Health matters. States that the office of the secretary of family and social services and a managed care organization may not prohibit a provider from participating in another insurance network. Defines “weighted average negotiated charge” …
HB 1005 – Indiana
Introduced: 2020 Status: Inactive / Dead
Health and insurance matters. Establishes the importation of prescription drugs program (program) for the importation of prescription drugs to be administered by the state department of health (state department). Requires the state department to apply …
Ind. Code § 5-10-8-1. Definitions: Group Insurance for Public Employees – Indiana
Introduced: Status: Enacted
Definitions related to Group Insurance for Public Employees in Indiana.
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Ind. Code § 5-10-8-13. Prescription Drugs: Group Insurance for Public Employees – Indiana
Introduced: Status: Enacted
An employee health benefit plan that provides coverage for prescription drugs may designate a mail order or an Internet based pharmacy to provide prescription drugs to a covered individual.
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Ind. Code § 5-10-8-18. Removal of a prescription drug from a health plan formulary, changing of cost sharing requirements, or changing utilization review; requirements: Group Insurance for Public Employees – Indiana
Introduced: Status: Enacted
This section applies to a state employee health plan that uses a formulary, cost sharing, or utilization review for prescription drug coverage.
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Ind. Code § 5-10-8-19. Compliance with prior authorization requirements: Group Insurance for Public Employees – Indiana
Introduced: Status: Enacted
A self-insurance program established under this chapter to provide health care coverage shall comply with the prior authorization requirements that apply to a health plan under IC 27-1-37.5. See definition section Ind. Code § 5-10-8-1.
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Ind. Code § 5-10-8-20. Costs of prescription drugs: Group Insurance for Public Employees – Indiana
Introduced: Status: Enacted
Statute gives pharmacists the right to provide a covered individual with information concerning the amount of the covered individual’s cost share for a prescription drug. Pharmacists shall not be prohibited by a pharmacy benefits 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