HB 1604 IN

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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.

• Julie McGuire Republican · author
• Cyndi Carrasco Republican · sponsor
• Kyle Walker Republican · sponsor
• Aaron Freeman Republican · sponsor

1. Jan 21, 2025 First reading: referred to Committee on Insurance · lower
2. Jan 21, 2025 Authored by Representative McGuire · lower
3. Jan 21, 2025 Coauthored by Representatives King and Morris · lower
4. Jan 27, 2025 Representative Shackleford added as coauthor · lower
5. Feb 11, 2025 Committee report: amend do pass, adopted · lower
6. Feb 13, 2025 Second reading: ordered engrossed · lower
7. Feb 17, 2025 Senate sponsors: Senators Carrasco, Walker K, Freeman · lower
8. Feb 17, 2025 Third reading: passed; Roll Call 187: yeas 95, nays 0 · lower
9. Feb 18, 2025 Referred to the Senate · lower
10. Mar 3, 2025 First reading: referred to Committee on Insurance and Financial Institutions · upper
11. Mar 13, 2025 Senator Randolph added as cosponsor · upper
12. Mar 18, 2025 Senator Hunley added as cosponsor · upper
13. Mar 20, 2025 Senator Ford J.D. added as cosponsor · upper
14. Mar 20, 2025 Senator Qaddoura added as cosponsor · upper
15. Mar 20, 2025 Committee report: amend do pass, adopted · upper
16. Mar 24, 2025 Second reading: ordered engrossed · upper
17. Mar 25, 2025 Senator Yoder added as cosponsor · upper
18. Mar 26, 2025 Returned to the House with amendments · upper
19. Mar 25, 2025 Senator Rogers added as cosponsor · upper
20. Mar 25, 2025 Third reading: passed; Roll Call 293: yeas 44, nays 3 · upper
21. Mar 25, 2025 Senator Bohacek added as cosponsor · upper
22. Apr 15, 2025 House advisors appointed: King, Barrett, Campbell and Dant Chesser · lower
23. Apr 15, 2025 Motion to dissent filed · lower
24. Apr 15, 2025 House conferees appointed: McGuire and Shackleford · lower
25. Apr 15, 2025 House dissented from Senate amendments · lower
26. Apr 17, 2025 Senate advisors appointed: Randolph Lonnie M and Walker K · upper
27. Apr 17, 2025 Senate conferees appointed: Carrasco and Qaddoura · upper
28. Apr 22, 2025 CCR # 1 filed in the Senate · upper
29. Apr 22, 2025 CCR # 1 filed in the House · lower
30. Apr 23, 2025 Signed by the Speaker · lower
31. Apr 23, 2025 Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 521: yeas 91, nays 0 · lower
32. Apr 23, 2025 Conference Committee Report 1: adopted by the Senate; Roll Call 493: yeas 45, nays 2 · upper
33. Apr 24, 2025 Signed by the President Pro Tempore · upper
34. May 6, 2025 Signed by the Governor · executive
35. Apr 29, 2025 Signed by the President of the Senate · upper
36. May 6, 2025 Public Law 237 · lower