Prohibit certain insurance practices

As Introduced

136th
General Assembly

Regular
Session
H. B. No. 682

2025-2026

Representatives Craig, Manning

To
enact section 3902.65 of the Revised Code
to
prohibit certain insurance practices related to
physician-administered drugs for patients with chronic, complex,
rare, or life-threatening medical conditions.

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)
"Administer" means to directly apply a drug to the body of
a patient by injection, inhalation, ingestion, or any other means.

(2)
"Health care provider" means an individual who is licensed,
certified, or otherwise authorized to provide health care services in
this state.

(3)
"Independent hospital" means a hospital, or group of
hospitals, that files jointly one hospital financial statement as
required by section 5168.05 of the Revised Code, or if not filing
pursuant to that section, a similar financial statement, and that has
an annual patient service revenue derived in this state of less than
two billion dollars based on the financial statement.

(4)
"Pharmacy" includes a pharmacy located in or affiliated
with an independent hospital.

(5)
"Physician" means a person licensed under Chapter 4731. of
the Revised Code to practice medicine or surgery or osteopathic
medicine and surgery.

(6)
"Physician-administered drug" means a drug, other than a
vaccine, to which both of the following apply:

(a)
The drug cannot reasonably be self-administered by the patient to
whom the drug is prescribed or by an individual assisting the patient
with the self-administration.

(b)
The drug is typically administered by a physician or other health
care provider, including when acting under a physician's delegation
and supervision.

(7)
"Specified location" means a physician's office or
independent hospital. "Specified location" does not include
either of the following:

(a)
A hospital that is not an independent hospital;

(b)
A hospital that is part of a group of hospitals that are not
independent hospitals.

(B)
Notwithstanding section 3901.71 of the Revised Code, but subject to
division (C) of this section, a health benefit plan issued, amended,
or renewed on or after January 1, 2027, shall not do any of the
following with respect to physician-administered drugs when the
administration occurs on an outpatient basis in a specified location:

(1)
Require physician-administered drugs to be dispensed only by certain
pharmacies or only by pharmacies participating in the health plan
issuer's network;

(2)
If a physician-administered drug is otherwise covered, limit or
exclude coverage for the drug based on the covered person's choice of
pharmacy or because the drug is not dispensed by a pharmacy that
participates in the health plan issuer's network;

(3)
Require a physician or other health care provider participating in
the health plan issuer's network to bill or be reimbursed for the
delivery and administration of physician-administered drugs under the
pharmacy benefit instead of the medical benefit without both of the
following:

(a)
Informed consent from the covered person;

(b)
A written attestation by the covered person's physician or other
health care provider that a delay in the drug's administration will
not place the covered person at an increased health risk.

(4)
Require that a covered person pay an additional fee or impose
increased cost-sharing requirements for physician-administered drugs
based on the covered person's choice of pharmacy or because the drug
was not dispensed by a pharmacy that participates in the health plan
issuer's network.

(C)
This section applies only with respect to covered persons with a
chronic, complex, rare, or life-threatening medical condition and
whose physician or other health care provider determines any of the
following:

(1)
A delay of care would make disease progression probable.

(2)
The use of a pharmacy within the health plan issuer's network would
make death or patient harm probable or potentially cause a barrier to
the covered person's compliance with the plan of care.

(3)
It is necessary to have the drug dispensed by a different pharmacy
based on the timeliness of the delivery or on dosage requirements.

(D)
Nothing in this section shall be construed to do either of the
following:

(1)
Authorize a person to administer a drug when otherwise prohibited
under the laws of this state;

(2)
Modify drug administration requirements under the laws of this state,
including any requirements related to delegation and supervision of
drug administration.