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 healthcare services. Additionally, health insuring corporations are prohibited from imposing lifetime maximums on basic healthcare services and are required to submit detailed annual reports to the superintendent of insurance regarding compliance with cost-sharing practices.

The bill also introduces a comprehensive definition of "pharmacy benefit manager" and outlines their responsibilities, including negotiating drug prices and managing prescription drug benefits. Pharmacy benefit managers must adhere to existing insurance laws concerning copayments and cost-sharing, and if compliance affects an enrollee's eligibility for federal tax deductions related to health savings accounts, it will only apply after the enrollee meets the federal minimum deductible. Furthermore, the bill prohibits these managers from manipulating health plan terms based on financial assistance for prescription drugs and requires annual compliance certification to the superintendent of insurance. Existing sections related to pharmacy benefit management are repealed, with the new provisions applying to health benefit plans issued or renewed on or after January 1, 2027.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