Bill > HB682

This bill prohibits certain insurance practices related to physician-administered drugs for patients with chronic, complex, rare, or life-threatening medical conditions, defining "administer" as applying a drug to a patient's body, "health care provider" as a licensed professional, "independent hospital" as a hospital with less than two billion dollars in annual patient service revenue that files a specific financial statement, "pharmacy" to include those in or affiliated with independent hospitals, "physician" as a licensed medical practitioner, "physician-administered drug" as a non-vaccine drug that cannot be reasonably self-administered and is typically given by a medical professional, and "specified location" as a physician's office or independent hospital, excluding other types of hospitals. Effective January 1, 2027, health benefit plans cannot require these drugs, administered on an outpatient basis in a specified location, to be dispensed only by certain or in-network pharmacies, nor can they limit or exclude coverage based on pharmacy choice or impose additional fees or cost-sharing for using an out-of-network pharmacy. Furthermore, insurers cannot force physicians or other providers to bill for these drugs under the pharmacy benefit instead of the medical benefit without the patient's informed consent and a physician's attestation that delaying administration would not pose a health risk. These protections apply only when a physician or provider determines that a delay in care would worsen the condition, using an in-network pharmacy would cause harm or non-compliance, or a different pharmacy is necessary for timely delivery or dosage. The bill does not authorize drug administration where prohibited by law or modify existing drug administration requirements.

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https://www.legislature.ohio.gov/legislation/136/hb682