The bill amends sections 1751.12 and 1751.32 of the Revised Code and enacts new sections 3923.811 and 3959.21 to prohibit certain health insurance cost-sharing practices in Ohio. It mandates that copayments, cost sharing, and deductibles must be reasonable and not act as barriers to necessary healthcare services, ensuring that these charges do not exceed federal annual limitations or 40% of the total annual cost of providing covered health care services. Additionally, health insuring corporations are prohibited from imposing lifetime maximums on basic health care services and are required to submit annual compliance reports to the superintendent of insurance.

The bill also introduces a comprehensive definition of "pharmacy benefit manager" and outlines their responsibilities, including negotiating drug prices and managing prescription drug benefits. It requires pharmacy benefit managers to adhere to existing insurance laws regarding cost-sharing and prohibits them from manipulating health plan terms based on financial assistance information for prescription drugs. Furthermore, it mandates annual compliance certification to the superintendent of insurance and repeals existing sections related to pharmacy benefit management, with the new provisions applying to health benefit plans issued or renewed on or after January 1, 2027.

Statutes affected:
As Introduced: 1751.12, 1751.32