Regards prescription drugs and medication switching

sb160_02_PS

As Passed by the Senate

136th
General Assembly

Regular
Session
Sub. S. B. No. 160

2025-2026

Senators Liston, Johnson

Cosponsors: Senators Antonio,
Blackshear, Cirino, Craig, DeMora, Hicks-Hudson, Patton, Reineke,
Reynolds, Schaffer

To
enact section 3902.65 of the Revised Code
regarding
prescription drugs and medication switching under health benefit
plans.

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)
"Interchangeable biological product" and "generically
equivalent drug" have the same meanings as in section 3715.01 of
the Revised Code.

(2)
"Pharmacy" has the same meaning as in section 4729.01 of
the Revised Code.

(3)
"Rate of inflation" has the same meaning as in section
107.032 of the Revised Code.

(4)
"Wholesale acquisition cost" has the same meaning as in 42
U.S.C. 1395w-3a.

(B)
Subject to divisions (C), (D), and (E) of this section, a health plan
issuer shall not do any of the following during a health benefit plan
year:

(1)
Increase a covered person's cost sharing with respect to a drug;

(2)
Move a drug to a greater cost-share tier of a health benefit plan's
formulary;

(3)
Remove a drug from a health benefit plan's formulary, unless one of
the following occurred:

(a)
The United States food and drug administration issued a statement
about the drug calling into question the clinical safety of the drug.

(b)
The drug manufacturer notified the United States food and drug
administration of a permanent discontinuance or interruption of the
manufacture of the drug as required by 21 U.S.C. 356c.

(c)
The drug manufacturer has removed the drug from sale in the United
States.

(4)
Limit or reduce coverage of a drug with respect to a covered person
in any other way, including subjecting it to a new prior
authorization requirement during a plan year if the drug had not
previously been subjected to prior authorization requirement during
the plan year.

(C)
All of the following are permissible activities regarding a
prescribed drug for which a generically equivalent drug or
interchangeable biological product is available:

(1)
A pharmacist substituting the generically equivalent drug or
interchangeable biological product for the prescribed drug in
accordance with section 4729.38 of the Revised Code;

(2)
A health plan issuer permitting a covered person to use the
generically equivalent drug or interchangeable biological product
instead of the prescribed drug;

(3)
A covered person electing to use the generically equivalent drug or
interchangeable biological drug product instead of the prescribed
drug.

(D)
This section shall not be construed to do any of the following:

(1)
Prevent a health plan issuer from adding a drug to its formulary;

(2)
Prevent a health plan issuer from removing a drug from its formulary
if the drug manufacturer has removed the drug from sale in the United
States;

(3)
Prevent a health care provider from prescribing another drug covered
by the health benefit plan that the provider considers medically
appropriate for the covered person;

(4)
Prevent a pharmacist from substituting for a prescribed epinephrine
autoinjector another epinephrine autoinjector pursuant to section
4729.382 of the Revised Code.

(E)
If, at any point during a health benefit plan year, the wholesale
acquisition cost for a drug increases by more than five per cent plus
the rate of inflation, as compared to the average wholesale
acquisition cost for the previous plan year, division (B) of this
section does not apply to that drug for the remainder of the plan
year. If a health plan issuer seeks to take an action described in
division (B) of this section for a drug subject to such a price
increase, it shall maintain supporting documentation that justifies
the action for a period of three years after the effective date of
the price increase and shall provide the supporting documentation to
the department of insurance upon the department's request.

(F)
A violation of this section shall be considered an unfair and
deceptive practice in the business of insurance for purposes of
section 3901.21 of the Revised Code.

(G)
This section applies notwithstanding section 3901.71 of the Revised
Code.

Section
2.
Section
3902.65 of the Revised Code, as enacted by this act, applies to
health benefit plans, as defined in section 3922.01 of the Revised
Code, that are delivered, issued for delivery, modified, or renewed
on or after January 1, 2028.