All Roll Calls
Yes: 265 • No: 13
IndianaSB 140First Regular Session 124th General Assembly (2025)Senate
Pharmacy benefits.
Sponsored By: Ed Charbonneau (Republican)
Signed by Governor
Summary
Requires an insurer, a pharmacy benefit manager, or any other administrator of pharmacy benefits to ensure that a network utilized by the insurer, pharmacy benefit manager, or other administrator is reasonably adequate and accessible and file an annual report regarding the network with the commissioner of the department of insurance (commissioner). Sets forth certain limitations and requirements with respect to the provision of pharmacy or pharmacist services under a health plan. Allows any insured, pharmacy, or pharmacist impacted by an alleged violation to file a complaint with the commissioner. Provides that the commissioner may order reimbursement to any person who has incurred a monetary loss as a result of a violation. Requires, if a pharmacy benefit manger is used with regard to a state employee health plan, the state personnel department to either create a pharmacy benefit manager or contract with an insurer, a pharmacy benefit manager, or other administrator. Prohibits a third party administrator from: (1) requiring, as a condition of a plan sponsor entering into a contract with the third party administrator, that the plan sponsor enter into a contract with a particular pharmacy benefit manager; or (2) charging a different fee for services provided by the third party administrator to a plan sponsor based on the plan sponsor's selection of a particular pharmacy benefit manager. Urges the legislative council to assign to the appropriate study committee the task of studying the topic of contracts for pharmacy benefit coverage under the Medicaid program and a state employee health plan.
health and provider servicesappropriationsthe houseinsurance
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 8 benefits, 0 costs, 0 mixed.
More choice for pharmacy customers
Beginning January 1, 2026, covered plans generally cannot require an affiliated pharmacy, including for specialty drugs, or give affiliates lower patient cost sharing. They cannot set stricter drug quantity or refill limits elsewhere, or discriminate against local pharmacies willing to accept network terms. Required mail-order use remains allowed; accurate price and network messages must include all eligible nonaffiliated pharmacies, and network-compliant incentives remain allowed. These rules apply to policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025. Medicaid and managed care organizations are excluded; state employee plans follow separate rules.
Money recovery for pharmacy benefit violations
Beginning January 1, 2026, insured people, pharmacies, and pharmacists can report pharmacy-benefit law violations to Indiana's insurance commissioner. The commissioner must investigate complaints and issue decisions. The commissioner can order repayment to a person who lost money because of a violation, alongside other available remedies or penalties. Repayment is not automatic, and the law sets no fixed amount or formula.
Nearby pharmacy access for covered patients
Beginning January 1, 2026, covered plans must maintain adequate, accessible pharmacy networks, not just mail-order service. Where services are available, a non-mail-order pharmacy must be within 30 miles of each insured person's home. Plans must submit annual network reports for Indiana's insurance commissioner to review; sensitive business information stays confidential, but non-identifying totals may be public. These rules cover policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025. Medicaid, managed care organizations, Medicare Part D, and specified self-insured hospital or health-system plans whose sponsors own pharmacies are generally excluded; state employee plans follow separate rules.
Pharmacists can share cheaper medicine options
Beginning January 1, 2026, covered insurers and pharmacy benefit managers cannot block or punish pharmacists for discussing available lower-cost medicines. They also cannot punish pharmacies for selling those alternatives. The protection does not guarantee savings and applies to policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025. Medicaid, managed care organizations, Medicare Part D, and specified self-insured hospital or health-system plans whose sponsors own pharmacies are generally excluded. State employee plans follow separate rules.
Employers choose their pharmacy benefit manager
Beginning January 1, 2026, third-party plan administrators cannot require a particular pharmacy benefit manager as a condition of contracting. They also cannot charge different service fees based on that choice. This protects self-funded plan sponsors with more than 100 employees or members. It covers policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025. It does not directly change workers' coverage or cost sharing.
Minimum payments protect covered pharmacies
Beginning January 1, 2026, covered payers must pay pharmacies the greater of their own or affiliated pharmacy's rate and a cost-based minimum. The comparison uses the same drug's national drug code or the same service, accounting for fees and money returned to the payer. For licensed premises, the minimum is the drug's purchase cost after discounts and adjustments, plus a fair, reasonable dispensing fee; otherwise, it is the federal National Average Drug Acquisition Cost plus Indiana's Medicaid fee-for-service dispensing fee. This applies to policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025. Medicaid, managed care organizations, Medicare Part D, and specified self-insured hospital or health-system plans whose sponsors own pharmacies are generally excluded; state employee plans follow separate rules.
Pharmacies gain payment and contract protections
Beginning January 1, 2026, covered pharmacy contracts must bar later claim denials, payment cuts, or takebacks after a paid claim response. Fraud and actual overpayments—duplicate or mistaken payments—remain exceptions, but dispensing fees cannot be taken back when the correct medicine was dispensed. Covered payers also cannot demand an extra affiliate contract or require acceptance of rates for an affiliate outside the contract. These protections cover policies and contracts issued, delivered, entered into, renewed, or amended after December 31, 2025; Medicaid and managed care organizations are excluded, and state employee plans follow separate rules. The takeback protections also generally exclude Medicare Part D and specified self-insured hospital or health-system plans whose sponsors own pharmacies.
State controls employee pharmacy benefit data
Beginning January 1, 2026, Indiana's State Personnel Department must choose how to run pharmacy benefits when its employee plan uses a pharmacy benefit manager. It must create one in-house or contract with an insurer, pharmacy benefit manager, or another pharmacy-benefit administrator. Data collected by the contractor while running the contract belongs to the state. This rule does not itself change employee coverage or cost sharing.
Sponsors & Cosponsors
Sponsor
Ed Charbonneau
Republican • Senate
Cosponsors
Andy Zay
Affiliation unavailable
Chris Campbell
Democratic • House
Gary Byrne
Republican • Senate
Julie McGuire
Republican • House
Lonnie Randolph
Democratic • Senate
Robin Shackleford
Democratic • House
Tyler Johnson
Republican • Senate
Vaneta Becker
Republican • Senate
Roll Call Votes
House vote • 4/24/2025
Rules Suspended. Conference Committee Report 1: adopted by the House
Yes: 84 • No: 1
Senate vote • 4/24/2025
Rules Suspended. Conference Committee Report 1: adopted by the Senate
Yes: 39 • No: 10
House vote • 4/15/2025
Third reading: passed
Yes: 95 • No: 0
Senate vote • 2/20/2025
Third reading: passed
Yes: 47 • No: 2
Actions Timeline
Signed by the Governor
5/6/2025SenatePublic Law 189
5/6/2025SenateSigned by the President of the Senate
4/29/2025SenateSigned by the Speaker
4/25/2025HouseCCR # 1 filed in the House
4/24/2025HouseCCR # 1 filed in the Senate
4/24/2025SenateRules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 560: yeas 84, nays 1
4/24/2025HouseRules Suspended. Conference Committee Report 1: adopted by the Senate; Roll Call 523: yeas 39, nays 10
4/24/2025SenateSigned by the President Pro Tempore
4/24/2025SenateSenate advisors appointed: Jackson L, Johnson T and Zay
4/17/2025SenateSenate conferees appointed: Charbonneau and Ford J.D.
4/17/2025SenateSenate dissented from House amendments
4/16/2025SenateMotion to dissent filed
4/16/2025SenateHouse advisors appointed: Lehman, Carbaugh, Barrett, Dant Chesser and Shackleford
4/16/2025HouseReturned to the Senate with amendments
4/16/2025HouseHouse conferees appointed: McGuire and Campbell
4/16/2025HouseThird reading: passed; Roll Call 446: yeas 95, nays 0
4/15/2025HouseAmendment #3 (Lehman) prevailed; voice vote
4/14/2025HouseSecond reading: amended, ordered engrossed
4/14/2025HouseAmendment #1 (Carbaugh) prevailed; voice vote
4/14/2025HouseCommittee report: amend do pass, adopted
4/8/2025HouseRepresentative Campbell added as cosponsor
3/13/2025HouseRepresentative Shackleford added as cosponsor
3/13/2025HouseFirst reading: referred to Committee on Insurance
3/3/2025HouseReferred to the House
2/21/2025Senate
Bill Text
Engrossed Senate Bill (H)
Engrossed Senate Bill (S)
Enrolled Senate Bill (S)
Introduced Senate Bill (S)
Senate Bill (H)
Senate Bill (S)
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