Cap cost sharing for prescription insulin drugs, diabetes devices

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 263

2025-2026

Representatives Abdullahi, Hall, T.

Cosponsors: Representatives Brennan,
Troy, Synenberg, McNally, Sweeney, Rader, Baker, Cockley, Grim,
White, E., Hall, D., Piccolantonio, Brewer, Brent, Somani, Sims,
Miller, J., Brownlee, Mohamed, Lett, Isaacsohn

A
BILL

To
enact section 3902.65 of the Revised Code
to
cap cost sharing for prescription insulin drugs, diabetes devices,
and diabetic ketoacidosis devices.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
section 3902.65 of the Revised Code be enacted to read as follows:

Sec.
3902.65.
(A)
As used in this section:

(1)
"Prescription insulin drug" means a prescription drug that
contains insulin and is used to treat diabetes;

(2)
"Diabetes device" means a blood glucose test strip,
continuous glucose monitor, lancet, lancing device, insulin syringe,
insulin pump, or other device used to cure, diagnose, mitigate,
prevent, or treat diabetes or low blood sugar, regardless of whether
a prescription is required to dispense the device.

(3)
"Diabetic ketoacidosis device" means a device that is used
to screen for or prevent diabetic ketoacidosis, regardless of whether
a prescription is required to dispense the device.

(B)
Notwithstanding section 3901.71 of the Revised Code, no health plan
issuer that provides coverage for prescription insulin drugs,
diabetes devices, or diabetic ketoacidosis devices pursuant to the
terms of a health benefit plan amended, issued, or renewed on or
after the effective date of this section shall require cost sharing
in excess of either of the following:

(1)
Thirty-five dollars in aggregate for a thirty-day supply of all
covered prescription insulin drugs prescribed for the covered person,
regardless of the amount or type of insulin needed to fill the
covered person's prescription;

(2)
One hundred dollars in aggregate for a thirty-day supply of all
covered diabetes devices or diabetic ketoacidosis devices used by the
covered person.

(C)
The cost-sharing limitations prescribed by division (B) of this
section apply regardless of any deductible, copayment, coinsurance,
or any other cost-sharing requirement that would otherwise apply to
the covered person under the health benefit plan.

(D)
This section does not prohibit a health plan issuer from reducing a
covered person's cost-sharing requirement for prescription insulin
drugs, diabetes devices, or diabetic ketoacidosis devices to amounts
less than those prescribed by division (B) of this section.