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SB 435

Prohibition on copay accumulator adjustments.

2025 Regular Session Introduced by J.D. Ford and 2 co-sponsors

SB 435 prohibits insurers from using copay accumulator adjustments, requiring manufacturer copay assistance to count toward patient deductibles and out-of-pocket maximums.

Senators Ford J.D. and Yoder added as coauthors
#health;billingandcosts #health;prescriptiondrugsandmedications #insurance;healthinsurance #insurance;healthmaintenanceorganizations(hmos) #stategovernment;employees
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Bill Summary · SB 435

Legislative bill overview

SB 435 would prohibit health insurers from using "copay accumulator adjustments" — practices where manufacturer copay assistance programs don't count toward a patient's deductible or out-of-pocket maximum. The bill aims to prevent insurers from essentially negating the financial help that drug manufacturers provide to patients, requiring all copay assistance to count toward cost-sharing requirements.

Why is this important

Copay accumulators create a hidden cost burden for patients with expensive medications, particularly those with chronic or serious conditions. Without this prohibition, patients receiving manufacturer assistance may still face unexpected out-of-pocket costs after reaching their deductible, effectively undermining the intended financial relief and potentially limiting medication access for vulnerable populations.

Potential points of contention

  • Insurance industry opposition: Insurers argue accumulators help control healthcare costs and prevent moral hazard; prohibiting them could increase insurance premiums
  • Scope and enforcement: Unclear whether the ban applies only to fully-insured plans, self-insured plans, or all coverage types, and how compliance would be monitored
  • Federal preemption questions: Potential conflict with existing federal regulations (ERISA) governing self-insured employer plans, which may limit Indiana's authority to impose requirements

Compiled from official sources — confirm details with the bill’s official record.

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