SB 140 and SB 480 / Chamber Opposes in Part
The House Insurance Committee took up two measures last week: one that addresses prior authorization and another that targets pharmacy benefit managers (PBMs). Committee Chairman Rep. Martin Carbaugh (R-Fort Wayne) announced that both bills will be held for further consideration.
Senate Bill 140, authored by Sen. Ed Charbonneau (R-Valparaiso), targets PBMs and introduces prohibitions against them owning pharmacies or contracting with affiliated health plans. The Chamber opposes these ownership prohibitions, arguing they may force PBMs to divest or exit Indiana’s market, reducing competition and employer choice and thus diminishing leverage to control healthcare costs. Additionally, the Chamber objects to restrictions preventing health plans from incentivizing mail order or specialty pharmacies, asserting these channels reduce medication costs.
Regarding pharmacy reimbursement, the Chamber supports adequate reimbursement provisions requiring pharmacies to be paid no less than what PBMs reimburse affiliated pharmacies or the pharmacy’s actual acquisition cost. However, there are concerns about mandating an additional professional dispensing fee ($10.48 per prescription), as it could significantly increase costs to employers and consumers.
Senate Bill 480, authored by Sen. Tyler Johnson (R-Leo), addresses health insurance companies and prior authorization. The Chamber supports the transparency measures in the bill, which require the publication of authorization criteria and provider statistics online, as they enhance accountability. However, concerns remain regarding compressed review deadlines and automatic approvals, which could unintentionally undermine proper clinical review and pose risks to plan integrity.
