The bill seeks to amend sections 1751.12 and 1751.32 of the Revised Code and enact new sections 3923.811 and 3959.21, with a focus on prohibiting certain health insurance cost-sharing practices. It mandates that health insuring corporations ensure that copayments, cost sharing, and deductibles are reasonable and do not hinder access to necessary health care services. Specifically, these charges must not exceed the annual limitation on cost sharing as defined under federal law or 40% of the total annual cost of providing covered health care services. The bill also requires compliance verification by actuaries and prohibits lifetime maximums on basic health care services, with some exceptions for inpatient hospital services.

Additionally, the bill introduces regulations for sickness and accident insurers, requiring them to adhere to similar cost-sharing limitations and ensuring that coverage terms are not influenced by the availability of financial assistance for prescription drugs. It establishes a comprehensive definition of "pharmacy benefit manager" and outlines their services, mandating compliance with existing insurance laws regarding copayments and deductibles. The bill also requires pharmacy benefit managers to certify their compliance annually and repeals the existing sections 1751.12 and 1751.32, indicating a significant update to the regulatory framework. These amendments will take effect for health benefit plans issued or renewed on or after January 1, 2027.

Statutes affected:
As Introduced: 1751.12, 1751.32