Limitation on cost sharing; calculating covered individual's contribution
Ind. Code § 27-1-24.5-27.7
in effectSec. 27.7. (a) This section applies to a health plan that is issued, delivered, amended, or renewed after December 31, 2025.
(b) A pharmacy benefit manager shall 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 administered by the pharmacy benefit manager;
(2) are life-saving or intended to manage chronic pain; and
(3) do not have an approved generic version.
(c) Except as provided in subsection (d), when calculating a covered individual's contribution to an applicable cost sharing requirement, a pharmacy benefit manager must include any cost sharing amounts paid:
(1) by the covered individual; or
(2) on behalf of the covered individual by another person.
(d) If application of subsection (c) would result in a covered individual becoming ineligible for a health savings account under Section 223 of the Internal Revenue Code, the requirement under subsection (c) applies with respect to the deductible of a high deductible health plan after the covered individual satisfies the minimum deductible under Section 223 of the Internal Revenue Code. However, subsection (c) applies to items or services that are preventative care under Section 223(c)(2)(C) of the Internal Revenue Code regardless of whether the minimum deductible under Section 223 of the Internal Revenue Code is satisfied.
(e) A pharmacy benefit manager may not directly or indirectly:
(1) set;
(2) alter;
(3) implement; or
(4) condition;
the terms of health plan coverage, including the benefit design, based in part or entirely on information about the availability or amount of financial or product assistance available for a prescription drug.
As added by P.L.237-2025, SEC.8.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026