As Introduced

136th General Assembly

Regular Session H. B. No. 448

2025-2026

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.