Ohio HB 229: Establish licensing process, contract requirements for PBMs

Summary

This bill establishes a new licensing and regulatory framework for pharmacy benefit managers in Ohio, requiring them to obtain state licensure starting July 1, 2027, and comply with specific contractual and operational requirements overseen by the superintendent of insurance. The bill affects pharmacy benefit managers operating in Ohio, pharmacies, health insurers, and employers or plans that use pharmacy benefit managers to administer prescription drug benefits.

Bill Text

(136th General Assembly)

(Substitute
House Bill Number 229)

AN
ACT

To amend sections 1751.92,
3905.24, 3923.87, 3959.01, 3959.111, 3959.12, and 3959.20; to amend,
for the purpose of adopting new section numbers as indicated in
parentheses, sections 3959.111 (3957.25), 3959.20 (3957.26), and
3959.22 (3957.27); and to enact sections 3957.01, 3957.02, 3957.03,
3957.04, 3957.05, 3957.06, 3957.07, 3957.08, 3957.09, 3957.10,
3957.11, 3957.12, 3957.13, 3957.14, 3957.15, 3957.16, and 3957.99 of
the Revised Code to establish a stand-alone licensing process and new
contractual requirements for pharmacy benefit managers.

Be
it enacted by the General Assembly of the State of Ohio:

Section
1. That
sections 1751.92,
3905.24,
3923.87,
3959.01,
3959.111, 3959.12, and 3959.20 be amended; sections 3959.111
(3957.25), 3959.20 (3957.26), and 3959.22 (3957.27)
be amended for
the purpose of adopting new section numbers as indicated in
parentheses; and
sections 3957.01, 3957.02, 3957.03, 3957.04, 3957.05, 3957.06,
3957.07, 3957.08, 3957.09, 3957.10, 3957.11, 3957.12, 3957.13,
3957.14, 3957.15, 3957.16, and 3957.99 of the Revised Code be enacted
to read as follows:

Sec.
1751.92. Each
health insuring corporation shall comply with the requirements of
section 3959.20
3957.26
of
the Revised Code as they pertain to health plan issuers. 

As
used in this section, "health plan issuer" has the same
meaning as in section 3922.01 of the Revised Code. 

Sec.
3905.24. (A)(1)
All records and other information obtained by the superintendent of
insurance or the superintendent's deputies, examiners, assistants, or
other employees, or agents relating to an investigation of an
applicant for licensure under this chapter, or of an agent,
solicitor, broker, or other person licensed or appointed under this
chapter or Chapter 3951.,
3957.,
or 3959. of the Revised Code, are confidential and are not public
records as defined in section 149.43 of the Revised Code until the
applicant, licensee, or appointee is provided notice and opportunity
for hearing pursuant to Chapter 119. of the Revised Code with respect
to such records or information. If no administrative action is
initiated with respect to a particular matter about which the
superintendent obtained records or other information as part of an
investigation, all such records and information relating to that
matter shall remain confidential for three years after the file on
the matter is closed.

(2)
Division (A)(1) of this section applies only to investigations that
could result in administrative action under Title XVII or XXXIX or
Chapter 119. of the Revised Code.

(B)
The records and other information described in division (A) of this
section shall remain confidential for all purposes except when it is
appropriate for the superintendent and the superintendent's deputies,
examiners, assistants, or other employees, or agents to take official
action regarding the affairs of the applicant, licensee, or appointee
or in connection with actual or potential criminal proceedings.

(C)
Notwithstanding divisions (A) and (B) of this section, the
superintendent may do either of the following:

(1)
Share records and other information that are the subject of this
section with the chief deputy rehabilitator, the chief deputy
liquidator, other deputy rehabilitators and liquidators, and any
other person employed by, or acting on behalf of, the superintendent
pursuant to Chapter 3901. or 3903. of the Revised Code, with other
local, state, federal, and international regulatory and law
enforcement agencies, with local, state, and federal prosecutors, and
with the national association of insurance commissioners and its
affiliates and subsidiaries, provided that the recipient agrees to
maintain the confidential status of the confidential record or other
information and has authority to do so;

(2)
Disclose records and other information that are the subject of this
section in the furtherance of any regulatory or legal action brought
by or on behalf of the superintendent or the state, resulting from
the exercise of the superintendent's official duties.

(D)
Notwithstanding divisions (A), (B), and (C) of this section, the
superintendent may authorize the national association of insurance
commissioners and its affiliates and subsidiaries by agreement to
share confidential records and other information received pursuant to
division (C)(1) of this section with local, state, federal, and
international regulatory and law enforcement agencies and with local,
state, and federal prosecutors, provided that the recipient agrees to
maintain the confidential status of the confidential record or other
information and has authority to do so.

(E)
Notwithstanding divisions (A), (B), and (C) of this section, the
chief deputy rehabilitator, the chief deputy liquidator, and other
deputy rehabilitators and liquidators may disclose records and other
information that are the subject of this section in the furtherance
of any regulatory or le