Bill > SB207

This bill addresses several key provisions related to health insurance cost-sharing practices in Ohio. It prohibits health insurance corporations, sickness and accident insurers, and pharmacy benefit managers from imposing copayments, cost-sharing, and deductibles that exceed the annual limitation set by federal law (42 U.S.C. 18022). The bill restricts insurers from setting coverage terms based on the availability of financial assistance for prescription drugs and requires them to calculate patient contributions to costs by including all amounts paid by or on behalf of the patient. For brand-name prescription drugs with generic equivalents, insurers can exclude third-party payments unless the prescriber determines the brand drug is medically necessary. The legislation also introduces specific provisions for high-deductible health plans linked to health savings accounts, ensuring that patients don't lose tax deduction eligibility. Pharmacy benefit managers are now subject to oversight by the state superintendent of insurance and must comply with the new cost-sharing limitations. These changes will apply to health benefit plans delivered, issued, modified, or renewed on or after January 1, 2027, and require annual certification of compliance from insurers and pharmacy benefit managers.

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https://www.legislature.ohio.gov/legislation/136/sb207