Apply prescription drug rebates to cost-sharing requirements

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 448

2025-2026

Representatives Baker, Barhorst

To
enact section 3902.65 of the Revised Code
to
apply prescription drug rebates to cost-sharing requirements.

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)
For the purposes of this section:

(1)
"Health plan issuer" has the same meaning as in section
3902.50 of the Revised Code, except it excludes the public employee
benefit plan covering state employees who are paid directly by
warrant of the director of budget and management, including elected
state officials.

(2)
"Price protection rebate" means a negotiated price
concession that accrues directly or indirectly to a health plan
issuer, or other party on behalf of the health plan issuer, in the
event of an increase in the wholesale acquisition cost of a drug
above a specified threshold.

(3)
"Rebate" includes both of the following:

(a)
Negotiated price concessions, including base price concessions,
whether described as a rebate or otherwise, and reasonable estimates
of any price protection rebates and performance-based price
concessions that may accrue directly or indirectly to the health plan
issuer during the coverage year from a manufacturer, dispensing
pharmacy, or other party in connection with the dispensing or
administration of a prescription drug;

(b)
Reasonable estimates of any negotiated price concessions, fees, and
other administrative costs that are passed through, or are reasonably
anticipated to be passed through, to the health plan issuer and serve
to reduce the health plan issuer's liability for a prescription drug.

(B)
A health plan issuer shall calculate a covered person's cost sharing
for a prescription drug at the point of sale based on a price that is
reduced by one hundred per cent of all rebates received, or to be
received, in connection with the dispensing or administration of the
prescription drug.

(C)
Nothing in this section prohibits a health plan issuer from
decreasing a covered person's cost-sharing amount for a prescription
drug by more than the amount required by division (A) of this
section.

(D)
In implementing the requirements of this section, the superintendent
of insurance shall only regulate a health plan issuer to the extent
permissible under applicable law.

(E)(1)
In complying with the provisions of this section, a health plan
issuer, or its agent, shall not publish or otherwise reveal
information regarding the actual amount of rebates a health plan
issuer receives on a product or therapeutic class of products,
manufacturer, or pharmacy-specific basis.

(2)
Documents and other evidence described in division (E)(1) of this
section are confidential, not public records for the purposes of
section 149.43 of the Revised Code, and shall not be released
directly or indirectly, or in a manner that would allow for the
identification of an individual product, therapeutic class of
products, manufacturer, or pharmacy, or in a manner that would have
the potential to compromise the financial, competitive, or
proprietary nature of the information.

(3)
A health plan issuer shall impose the confidentiality protections and
requirements of this section on any agent or other third party that
performs health care or administrative services on behalf of the
health plan issuer that may receive or have access to rebate
information.

(F)
Whoever violates this section is engaged in an unfair and deceptive
insurance act or practice under sections 3901.19 to 3901.26 of the
Revised Code, and is subject to proceedings pursuant to those
sections.