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. It requires that copayments, cost sharing, and deductibles be reasonable and not serve as barriers to necessary health care services. Health insuring corporations must ensure that these charges do 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. Additionally, the bill prohibits health insuring corporations from imposing lifetime maximums on basic health care services and mandates annual compliance reports to the superintendent of insurance.

The bill also introduces a comprehensive definition of "pharmacy benefit manager" and outlines their services, including negotiating drug prices and managing prescription drug benefits. It requires pharmacy benefit managers to comply with existing insurance laws regarding copayments and prohibits them from manipulating health plan terms based on financial assistance information for prescription drugs. Furthermore, pharmacy benefit managers must certify their compliance with these requirements annually to the superintendent of insurance. The bill repeals existing sections related to pharmacy benefit management and clarifies that the new provisions will apply to health benefit plans issued or renewed on or after January 1, 2027, aiming to enhance transparency and accountability in the sector while protecting enrollees.

Statutes affected:
As Introduced: 1751.12, 1751.32