As Introduced
136th General Assembly
Regular Session H. B. No. 192
2025-2026
Representatives Barhorst, Fischer
Cosponsors: Representatives McClain, Gross, Dean, Johnson, Mullins, Odioso
A B I L L
To amend section 3902.50 and to enact sections
3902.75, 3902.76, and 3959.151 of the Revised
Code to limit insurer accreditation requirements
for pharmacies, to implement drug cost reporting
requirements for pharmacy benefit managers, and
to name this act the Community Pharmacy
Protection Act.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 3902.50 be amended and sections
3902.75, 3902.76, and 3959.151 of the Revised Code be enacted to
read as follows:
Sec. 3902.50. As used in sections 3902.50 to 3902.72
3902.76 of the Revised Code:
(A) "Ambulance" has the same meaning as in section 4765.01
of the Revised Code.
(B) "Clinical laboratory services" has the same meaning as
in section 4731.65 of the Revised Code.
(C) "Cost sharing" means the cost to a covered person
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under a health benefit plan according to any copayment,
coinsurance, deductible, or other out-of-pocket expense
requirement.
(D) "Covered" or "coverage" means the provision of
benefits related to health care services to a covered person in
accordance with a health benefit plan.
(E) "Covered person," "health benefit plan," "health care
services," and "health plan issuer" have the same meanings as in
section 3922.01 of the Revised Code.
(F) "Drug" has the same meaning as in section 4729.01 of
the Revised Code.
(G) "Emergency facility" has the same meaning as in
section 3701.74 of the Revised Code.
(H) "Emergency services" means all of the following as
described in 42 U.S.C. 1395dd:
(1) Medical screening examinations undertaken to determine
whether an emergency medical condition exists;
(2) Treatment necessary to stabilize an emergency medical
condition;
(3) Appropriate transfers undertaken prior to an emergency
medical condition being stabilized.
(I) "Health care practitioner" has the same meaning as in
section 3701.74 of the Revised Code.
(J) "Pharmacy benefit manager" has the same meaning as in
section 3959.01 of the Revised Code.
(K) "Prior authorization requirement" means any practice
implemented by a health plan issuer in which coverage of a
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health care service, device, or drug is dependent upon a covered
person or a provider obtaining approval from the health plan
issuer prior to the service, device, or drug being performed,
received, or prescribed, as applicable. "Prior authorization
requirement" includes prospective or utilization review
procedures conducted prior to providing a health care service,
device, or drug.
(L) "Unanticipated out-of-network care" means health care
services, including clinical laboratory services, that are
covered under a health benefit plan and that are provided by an
out-of-network provider when either of the following conditions
applies:
(1) The covered person did not have the ability to request
such services from an in-network provider.
(2) The services provided were emergency services.
Sec. 3902.75. (A) As used in sections 3902.75 and 3902.76
of the Revised Code:
(1) Notwithstanding section 3902.50 of the Revised Code,
"health plan issuer" has the same meaning as in section 3922.01
of the Revised Code but also includes an auditing entity, as
defined in section 3901.81 of the Revised Code.
(2) "Pharmacy" has the same meaning as in section 4729.01
of the Revised Code and also includes a dispensing physician.
(B) A health plan issuer that offers, issues, or
administers a health benefit plan that covers pharmacy services,
including prescription drug coverage, shall not require a
pharmacy, as a condition of participation in the health plan
issuer's network, to meet accreditation standards or
certification requirements that are inconsistent with or in
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addition to those of the state board of pharmacy.
(C) In addition to any other remedies provided by law, any
covered person or pharmacy affected by a violation of this
section may file a formal complaint with the superintendent of
insurance.
Sec. 3902.76. (A) The superintendent of insurance shall
evaluate any complaint filed under section 3902.75 of the
Revised Code.
(B)(1) If the superintendent determines, based on a
complaint by a covered person or pharmacy or other information
available to the superintendent, that a health plan issuer or
one or more of the health plan issuer's intermediaries has
violated section 3902.75 of the Revised Code, the superintendent
shall do both of the following:
(a) Issue a notice of violation to the health plan issuer
or intermediary that clearly explains the violation;
(b) Impose an administrative penalty on the health plan
issuer or intermediary of one thousand dollars for each
violation.
(2) Each day that a violation of section 3902.75 of the
Revised Code continues after the health plan issuer or
intermediary receives notice of violation under division (B)(1)
(a) of this section is considered a separate violation for the
purposes of the administrative penalty under division (B)(1)(b)
of this section.
(C) Before imposing an administrative penalty under this
section, the superintendent shall afford the health plan issuer
or intermediary an opportunity for an adjudication hearing under
Chapter 119. of the Revised Code. At the hearing, the health
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plan issuer or intermediary may challenge the superintendent's
determination that a violation occurred, the superintendent's
imposition of an administrative penalty, or both. The health
plan issuer or intermediary may appeal the superintendent's
determination and imposition of an administrative penalty in
accordance with section 119.12 of the Revised Code.
(D) An administrative penalty collected under this section
shall be deposited into the state treasury to the credit of the
department of insurance operating fund created by section
3901.021 of the Revised Code.
Sec. 3959.151. (A) As used in this section, "machine-
readable format" means a digital representation of information
in a file that can be imported or read into a computer system
for further processing. "Machine-readable format" includes.XML
and.CSV formats.
(B)(1) Each pharmacy benefit manager shall quarterly
provide to the superintendent of insurance and to the pharmacy
benefit manager's contracted insurers and plan sponsors,
including contracted public employee benefit plans and
contracted employers offering a self-insurance program, an
electronic report of all drug claims processed the previous
quarter in a machine-readable format that is also readable in
plain language without the use of software.
(2) The electronic report provided to an insurer, a plan
sponsor, or the medicaid program shall include an itemized list
of the maximum allowable cost of each drug product from all drug
product claims processed by the pharmacy benefit manager in the
previous quarter for that insurer, that plan sponsor, or the
medicaid program. The electronic report provided to the
superintendent of insurance shall include an itemized list of
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the actual acquisition cost of each drug product from all drug
product claims processed by the pharmacy benefit manager in the
previous quarter for all insurers and plan sponsors.
(3) The itemized list shall notate the following for each
drug product:
(a) If the drug was procured pursuant to the pharmacy
benefit manager, insurer, plan sponsor, or department of
medicaid's drug formulary or list of covered drugs;
(b) If the drug was procured outside of the drug formulary
or list of covered drugs;
(c) If the drug is a brand-name drug;
(d) If the drug is a generic drug;
(e) If the drug is a specialty drug, including biological
products.
(C)(1) No agreement between a pharmacy benefit manager and
an insurer or plan sponsor, including a service agreement under
section 3959.15 of the Revised Code, that is entered into,
amended, or renewed on or after the effective date of this
section shall prohibit disclosure of any of the information
included in the itemized list required by division (B) of this
section.
(2) Notwithstanding division (B) of this section, a
pharmacy benefit manager is not required to disclose information
deemed proprietary or confidential by a service agreement
between the pharmacy benefit manager and an insurer or plan
sponsor that is entered into in accordance with section 3959.15
of the Revised Code before the effective date of this section,
and in effect on the date the information would otherwise be
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submitted as part of the itemized list required by division (B)
of this section.
(D) No pharmacy benefit manager shall retaliate against a
pharmacy in this state that reports an alleged violation of this
section or exercises a right or remedy under this section, by
doing any of the following:
(1) Terminating or refusing to renew a contract with the
pharmacy without providing notice to the pharmacy at least
ninety days in advance;
(2) Subjecting a pharmacy to increased audits without
providing notice to the pharmacy and a detailed description of
reason for the audit at least ninety days in advance;
(3) Failing to promptly pay a pharmacy in accordance with
sections 3901.381 to 3901.3814 of the Revised Code.
(E) If a pharmacy in this state believes that a pharmacy
benefit manager has violated this section, in addition to any
other remedies provided by law, a pharmacy may file a formal
complaint and provide evidence related to the complaint to the
superintendent of insurance.
(F) The superintendent of insurance shall adopt rules in
accordance with Chapter 119. of the Revised Code for the
purposes of implementing and administering this section.
Notwithstanding any provision of section 121.95 of the Revised
Code to the contrary, a regulatory restriction contained in a
rule adopted by the superintendent in accordance with this
section is not subject to sections 121.95 to 121.953 of the
Revised Code.
Section 2. That existing section 3902.50 of the Revised
Code is hereby repealed.
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Section 3. Sections 3902.75 and 3902.76 of the Revised
Code, as enacted in this act, apply to health benefit plans, as
defined in section 3922.01 of the Revised Code, delivered,
issued for delivery, modified, or renewed on or after the
effective date of those sections.
Section 4. Sections 3902.75 and 3902.76 of the Revised
Code, as enacted in this act, apply to contracts between health
plan issuers, as defined in section 3922.01 of the Revised Code,
and pharmacies entered into, modified, or renewed on or after
the effective date of those sections.
Section 5. This act shall be known as the Community
Pharmacy Protection Act.
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