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 1175 – Indiana
Introduced: 2022 Status: Inactive / Dead
Physician noncompete agreements. Specifies that the reasonable price of a noncompete agreement buyout may not exceed $75,000 under the following circumstances: (1) the physician’s employer is a hospital system located in Allen County; (2) the …
HB 1176 – Indiana
Introduced: 2020 Status: Enacted
First steps program. Provides that: (1) a health benefits plan; or (2) an employee health plan; may not require authorization for services specified in a covered individual’s individualized family service plan once the individualized family …
HB 1179 – Indiana
Introduced: 2019 Status: Inactive / Dead
Prior authorization of prescription drugs. Requires a health plan that denies prior authorization for a prescription drug to provide certain information in the notice of denial.
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HB 1180 – Indiana
Introduced: 2019 Status: Inactive / Dead
Pharmacy benefits. Requires a health plan that denies prior authorization for certain prescription drugs to provide an alternative list of prescription drugs covered by the health plan. Urges the legislative council to assign to an …
HB 1181 – Indiana
Introduced: 2023 Status: Inactive / Dead
Medicaid matters. Allows a provider that has entered into a contract with a managed care organization, after exhausting any internal procedures of the managed care organization for provider grievances and appeals, to request an administrative …
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