The proposed bill, H.B. No. 2025-2026, aims to enact section 3902.65 of the Revised Code, mandating that health benefit plans provide coverage for prescription drugs under specific conditions. Effective January 1, 2027, health plans that cover prescription drugs must include any drug approved by the United States Food and Drug Administration (FDA) for the treatment of a covered person's disease, disorder, or condition, provided that the drug is recognized by an approved prescription drug reference compendium or substantial peer-reviewed medical literature, and that coverage for the condition is not expressly excluded in the plan. Additionally, the bill stipulates that coverage must encompass all medically necessary services related to the administration of the prescription drug.

Furthermore, the bill prohibits health plan issuers from denying coverage based on "medical necessity" unless the denial is unrelated to the legal status of the drug's use. However, it clarifies that health benefit plans are not required to cover experimental drugs not approved by the FDA for the specific condition or drugs deemed contraindicated by the FDA. This legislation seeks to enhance access to necessary medications for individuals covered by health plans in Ohio.