Indiana § 27-1-24.5-27.7 Limitation on cost sharing; calculating covered individual's
contribution

Indiana Statutes

§ 27-1-24.5-27.7 — Limitation on cost sharing; calculating covered individual's contribution

Indiana § 27-1-24.5-27.7

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 24.5Pharmacy Benefit Managers

This text of Indiana § 27-1-24.5-27.7 (Limitation on cost sharing; calculating covered individual's contribution) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-24.5-27.7 (2026).

Text

Effective 1-1-2026. Sec. 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

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Effective 1-1-2026.
Sec. 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.