HB 1454 – Nonemergency Ambulance Service and Physician Order
Authored by Rep. Beau Baird (R-Greencastle)

Prohibits a health carrier, the office of the secretary of Family and Social Services, and contractors of the office from: (1) denying payments for nonemergency ambulance services when provided according to a properly executed physician order or certification statement; and (2) making reimbursement for nonemergency ambulance services contingent upon receipt of a physician’s order. Requires hospital boards to establish protocols concerning issuing orders for nonemergency transportation. Requires physicians to issue orders for nonemergency ambulance services and specifies contents of the order. Prohibits a health carrier from requiring a covered individual to make greater cost sharing payments for ambulance services that were provided by an out-of-network ambulance provider. Allows an out-of-network provider of ambulance services to directly bill a health carrier and specifies determination of reimbursement amount.

Chamber position: Oppose

The latest: Heard in committee but was held for further discussion among stakeholders.

Indiana Chamber action/commentary: This legislation is very similar to what was heard in the Senate last year. The problem is that ambulance runs are a unique health provider service. What this bill attempts to do is raise reimbursement levels for out-of-network ambulance providers. The Chamber testified against the bill because it drives up costs to fully insured plans, which are the most price-sensitive plans. It does not impact ERISA (Employee Retirement Income Security Act) plans and only affects less than 20% of the market. Chairman Bradford Barrett (R-Richmond) and author Rep. Baird held a meeting among stakeholders attempting to provide some solutions. The belief is an amendment will be drafted to set a date for looking at obtaining costs related to ambulance services. The Chamber will intently review that amendment and lobby based upon what that language ultimately entails, but we hope it will be acceptable.

SB 143 – Pharmacy Benefit Managers
Authored by Sen. Andy Zay (R-Huntington)

Requires the auditor of state to conduct an audit of prescription drug cost sharing for the Medicaid program every three state fiscal years. Adds requirements of pharmacy benefit managers (PBMs) when denying an appeal of the maximum allowable cost pricing of a prescription drug. Requires the Department of Insurance to develop a process for complaints regarding PBMs, including: (1) denied appeals of maximum allowable cost pricing; and (2) unfair, unjust or unlawful contract provisions. Allows a pharmacy or pharmacist to decline to provide pharmacist services to a covered individual if the acquisition cost to the pharmacy or pharmacist would exceed the amount received for the pharmacist services.

Chamber position: Oppose

The latest: The bill was amended to mirror West Virginia language that would allow the Family and Social Services Administration (FSSA) to provide a prescription drug benefit to a Medicaid recipient in a Medicaid risk-based managed care program until December 31, 2021. After that date, FSSA shall contract with an in-state postsecondary educational institution that has a pharmacy school to provide a prescription drug benefit to Medicaid recipients in a Medicaid risk-based managed care program.  Subsequently, the bill passed the Senate Insurance and Financial Institutions Committee 6-1. Senator Mike Gaskill (R-Pendleton) was the lone “no” vote and raised several questions that supported employers’ positions.

Indiana Chamber action/commentary: In 2020, Sen. Liz Brown (R-Fort Wayne) worked very hard to design a bill that listened to both sides of this issue: PBMs and pharmacies. At that time, the Chamber commented that less regulation was better and keeping costs down was of upmost importance. This year, the pharmacies favor the new bill language. They believe that they are getting at what the Supreme Court decided in the Rutledge case that states have the right to regulate PBMs and cannot hide behind ERISA as an excuse. Care Source, Anthem, CVS Health, the Pharmaceutical Care Management Association and PBMs all opposed the bill. These groups commented that the bill will drive up costs, add more regulations when we haven’t seen how last year’s bill is going to play out and undermine contracts already in place.

The Chamber had planned to testify in person against the bill but was unable to do so and thus submitted remarks electronically to the committee. We  believe this bill will drive up costs and it’s too early to take action when the ink is barely dry on the 2020 law. Many legislators seem to really oppose PBMs so we expect this bill to move in the Senate. It will be interesting to see what comments Sen. Brown will make as this bill moves to third reading.

Resource: Mike Ripley at (317) 264-6883 or email: mripley@indianachamber.com