Bill > HB699

This bill requires health plan issuers, which are companies that offer health insurance plans, to cover prescription drugs for individuals enrolled in their plans, starting January 1, 2027. Specifically, if a health plan covers prescription drugs and a drug is prescribed to treat a covered person's disease, disorder, or condition, the plan must provide coverage if the drug is approved by the U.S. Food and Drug Administration (FDA) for that specific condition, is recognized for treatment in an approved prescription drug reference compendium or through widely accepted peer-reviewed medical literature, and if coverage for the condition itself is not explicitly excluded by the plan. The coverage must also include any medically necessary services needed to administer the prescription drug. Furthermore, a health plan issuer cannot deny coverage for a prescription drug based on "medical necessity" unless the reason for denial is unrelated to the legal use of the drug. However, this bill does not mandate coverage for experimental drugs not approved by the FDA for the condition or for drugs that the FDA has determined should not be used for the specific condition.

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https://www.legislature.ohio.gov/legislation/136/hb699