# Indiana HB 1604: Cost sharing; out-of-pocket expense credit. Indiana HB 1604, Cost sharing; out-of-pocket expense credit., is a First Regular Session 124th General Assembly (2025) House bill sponsored by Julie McGuire (Republican); status signed, last action 2025-05-06 (Public Law 237); PRIA reads it as touching household money (as of 2026-10-17). - Canonical: https://policyrisk.com/state-bill/IN-HB1604-2025 - As of: 2026-10-17 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: Indiana HB 1604 - State: Indiana - Session: First Regular Session 124th General Assembly (2025) - Title: Cost sharing; out-of-pocket expense credit. - Status: signed - Chamber: House - Introduced: 2025-01-21 - Last action: 2025-05-06, Public Law 237 - Sponsor: Julie McGuire (Republican) - Cosponsors: 13 - Subjects: insurance, the senate, insurance and financial institutions - Touches household money: yes - Roll calls: 4 (275 yes, 5 no in all) - Economic provisions PRIA read: 4 ## Summary 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. ## Bill overview: provisions PRIA read - Patient payments and drug assistance protected: benefit, medium. Beginning January 1, 2026, insurers, administrators, and pharmacy benefit managers must count cost-sharing payments made by you or for you. Cost sharing includes copays, coinsurance, deductibles, and similar required charges. They cannot base coverage terms or benefit design on the availability or… - Yearly spending protection for certain prescriptions: benefit, medium. Beginning January 1, 2026, insurers, administrators, and pharmacy benefit managers must apply the federal yearly cost-sharing limit to qualifying prescriptions. Drugs must be covered, be life-saving or treat chronic pain, and have no approved generic version. The law uses the Affordable Care Act li… - Direct medical payments count toward deductibles: benefit, low. Beginning July 1, 2025, qualifying direct payments count toward your deductible and yearly out-of-pocket limit. This applies to health plans entered into or renewed after June 30, 2025. You must pay the provider directly for a medically necessary service covered by your plan. No claim for the servi… - Broader oversight for pharmacy benefit companies: mixed, low. Beginning January 1, 2026, Indiana’s pharmacy benefit manager rules cover more companies providing services under written agreements with health payors. Related agents, contractors, affiliates, and intermediaries that provide or oversee those services are also covered. Certain licensed health care… ## Sponsors and cosponsors - Sponsor: Julie McGuire (Republican), House - Cosponsor: Aaron Freeman (Republican), Senate - Cosponsor: Andrea Hunley (Democratic), Senate - Cosponsor: Cyndi Carrasco (Republican), Senate - Cosponsor: Fady Qaddoura (Democratic), Senate - Cosponsor: J.D. Ford (Democratic), Senate - Cosponsor: Joanna King (Republican), House - Cosponsor: Kyle Walker (Republican), Senate - Cosponsor: Linda Rogers (Republican), Senate - Cosponsor: Lonnie Randolph (Democratic), Senate - Cosponsor: Mike Bohacek (Republican), Senate - Cosponsor: Robert Morris (Republican), House - Cosponsor: Robin Shackleford (Democratic), House - Cosponsor: Shelli Yoder (Democratic), Senate ## Roll call votes | Date | Chamber | Motion | Result | Yes | No | Other | | --- | --- | --- | --- | --- | --- | --- | | 2025-04-23 | House | Rules Suspended. Conference Committee Report 1: adopted by the House | pass | 91 | 0 | | | 2025-04-23 | Senate | Conference Committee Report 1: adopted by the Senate | pass | 45 | 2 | | | 2025-03-25 | Senate | Third reading: passed | pass | 44 | 3 | | | 2025-02-17 | House | Third reading: passed | pass | 95 | 0 | | ## Actions (36) - 2025-05-06: Public Law 237 (House) - 2025-05-06: Signed by the Governor (House) - 2025-04-29: Signed by the President of the Senate (Senate) - 2025-04-24: Signed by the President Pro Tempore (Senate) - 2025-04-23: Conference Committee Report 1: adopted by the Senate; Roll Call 493: yeas 45, nays 2 (Senate) - 2025-04-23: Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 521: yeas 91, nays 0 (House) - 2025-04-23: Signed by the Speaker (House) - 2025-04-22: CCR # 1 filed in the House (House) - 2025-04-22: CCR # 1 filed in the Senate (Senate) - 2025-04-17: Senate conferees appointed: Carrasco and Qaddoura (Senate) - 2025-04-17: Senate advisors appointed: Randolph Lonnie M and Walker K (Senate) - 2025-04-15: House dissented from Senate amendments (House) - 2025-04-15: House conferees appointed: McGuire and Shackleford (House) - 2025-04-15: Motion to dissent filed (House) - 2025-04-15: House advisors appointed: King, Barrett, Campbell and Dant Chesser (House) - 2025-03-26: Returned to the House with amendments (Senate) - 2025-03-25: Senator Bohacek added as cosponsor (Senate) - 2025-03-25: Third reading: passed; Roll Call 293: yeas 44, nays 3 (Senate) - 2025-03-25: Senator Rogers added as cosponsor (Senate) - 2025-03-25: Senator Yoder added as cosponsor (Senate) - 2025-03-24: Second reading: ordered engrossed (Senate) - 2025-03-20: Committee report: amend do pass, adopted (Senate) - 2025-03-20: Senator Qaddoura added as cosponsor (Senate) - 2025-03-20: Senator Ford J.D. added as cosponsor (Senate) - 2025-03-18: Senator Hunley added as cosponsor (Senate) - 2025-03-13: Senator Randolph added as cosponsor (Senate) - 2025-03-03: First reading: referred to Committee on Insurance and Financial Institutions (Senate) - 2025-02-18: Referred to the Senate (House) - 2025-02-17: Third reading: passed; Roll Call 187: yeas 95, nays 0 (House) - 2025-02-17: Senate sponsors: Senators Carrasco, Walker K, Freeman (House) - 2025-02-13: Second reading: ordered engrossed (House) - 2025-02-11: Committee report: amend do pass, adopted (House) - 2025-01-27: Representative Shackleford added as coauthor (House) - 2025-01-21: Coauthored by Representatives King and Morris (House) - 2025-01-21: Authored by Representative McGuire (House) - 2025-01-21: First reading: referred to Committee on Insurance (House) ## Bill text - Enrolled House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.04.ENRS?format=pdf) - House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.03.COMS?format=pdf) - House Bill (S): [PDF](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.02.COMH?format=pdf) - Introduced House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.01.INTR?format=pdf) ## Related bills - SB 231: Various corrections matters. (signed) - SB 324: Criminal procedures. (signed) - SB 80: Code publication. (signed) - SB 453: Various tax matters. (signed) - SB 464: Financial institutions and consumer credit. (signed) - SB 371: Workforce matters. (signed) ## Sources - [Enrolled House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.04.ENRS?format=pdf) - [House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.03.COMS?format=pdf) - [House Bill (S) (PDF)](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.02.COMH?format=pdf) - [Introduced House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1604/versions/HB1604.01.INTR?format=pdf) ## Related - [SB 231: Various corrections matters.](https://policyrisk.com/state-bill/IN-SB231-2025) - [SB 324: Criminal procedures.](https://policyrisk.com/state-bill/IN-SB324-2025) - [SB 80: Code publication.](https://policyrisk.com/state-bill/IN-SB80-2025) - [SB 453: Various tax matters.](https://policyrisk.com/state-bill/IN-SB453-2025) - [SB 464: Financial institutions and consumer credit.](https://policyrisk.com/state-bill/IN-SB464-2025) - [SB 371: Workforce matters.](https://policyrisk.com/state-bill/IN-SB371-2025) - [Indiana bills](https://policyrisk.com/states/indiana/bills) - [Indiana state hub](https://policyrisk.com/states/indiana) - [All state legislation](https://policyrisk.com/state-bills) Source: PRIA, https://policyrisk.com/state-bill/IN-HB1604-2025 (as of 2026-10-17).