Bill Summary – FastDemocracy

OHIO LEGISLATIVE SERVICE COMMISSION
                                              Office of Research                            Legislative Budget
         www.lsc.ohio.gov                       and Drafting                                      Office
                            H.B. 384                               Bill Analysis
                  135th   General Assembly
                                                                   Click here for H.B. 384’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. Abdullahi and Hall
Effective Date:
Logan Briggs, Attorney
                                                          SUMMARY
                     Limits cost-sharing requirements that a health plan issuer may impose on a prescription
                          insulin drug or diabetes care device.
                                                DETAILED ANALYSIS
Insulin cost-sharing limit
       H.B. 384 limits cost-sharing requirements that a health plan issuer may impose on a
prescription insulin drug or diabetes care device. For prescription insulin drugs, the bill prohibits
cost-sharing requirements that exceed $35 in aggregate for a 30-day supply of all covered
prescription insulin drugs prescribed for the covered person. For diabetes care devices, the bill
prohibits cost-sharing requirements that exceed $100 in aggregate for a 30-day supply of all
covered diabetes care devices used by the covered person. However, a health plan issuer may
further reduce a cost-sharing requirement to an amount less than the $35 or $100 limit if it
chooses to do so.1
                          The limitations apply as follows:
                    1. Only to health plan issuers that provide coverage for prescription insulin drugs or
                       diabetes care devices;
                    2. Regardless of the amount or type of insulin needed to fill a covered person’s
                       prescription; and
1                 R.C. 3902.63(B) and (D).
                                                                                                           April 15, 2024
Office of Research and Drafting                   LSC                        Legislative Budget Office
      3. Regardless of any deductible, copayment, coinsurance, or any other cost-sharing
         requirement that would otherwise apply to the covered person under the health benefit
         plan.2
Exemption from Superintendent of Insurance review
        The bill exempts its cost-sharing limitations from an existing law that could prevent
them from being applied until a review by the Superintendent of Insurance has been conducted
with respect to mandated health benefits.3 Under current law, if the General Assembly enacts a
statute mandating health benefits, that statute cannot be applied to any health benefit plan
until the Superintendent of Insurance holds a hearing and determines that it can be applied
fully and equally in all respects to (1) employee benefit plans subject to regulation by the
federal “Employee Retirement Income Security Act of 1974,” (ERISA),4 and (2) employee benefit
plans established or modified by the state or its political subdivisions.5 ERISA appears to
preempt any state regulation of such plans.6
Definitions
       “Prescription insulin drug” means a prescription drug that contains insulin and is used to
           treat diabetes.
       “Diabetes care device” means any of the following when prescribed to cure, diagnose,
           mitigate, prevent, or treat diabetes or low blood sugar:
              Blood glucose test strip;
              Glucometer;
              Continuous glucose monitor;
              Lancet;
              Lancing device;
              Insulin syringe;
              Insulin pump.
       “Diabetes care device” also includes nonprescription kits for checking and recording
           blood ketone levels.7
2   R.C. 3902.63(B)(1) and (C).
3   R.C. 3902.63(B).
4   29 United States Code (U.S.C.) 1001.
5   R.C. 3901.71, not in the bill.
6   29 U.S.C. 1144.
7   R.C. 3902.63(A).
P a g e |2                                                                                  H.B. 384
                                                                                       As Introduced
Office of Research and Drafting                    LSC                           Legislative Budget Office
       “Cost sharing” means the cost to a covered person under a health benefit plan
           according to any copayment, coinsurance, deductible, or other out-of-pocket expense
           requirement.
       “Covered person” means a person covered by a health benefit plan.
       “Health plan issuer” means an entity subject to Ohio’s insurance laws that contracts to
           provide, pay for, or reimburse any of the costs of health care services. The term includes
           a sickness and accident insurer, a health insuring corporation, a fraternal benefit society,
           a self-funded multiple employer welfare arrangement, and a nonfederal, government
           health plan. The term also includes a third party administrator to the extent that the
           benefits the administrator is contracted to administer are subject to Ohio insurance
           laws or to the Superintendent’s jurisdiction.8
                                            HISTORY
                               Action                                           Date
Introduced                                                    01-24-24
ANHB0384IN-135/ar
8   R.C. 3902.50, not in the bill.
P a g e |3                                                                                      H.B. 384
                                                                                           As Introduced