Bill Text: OH HB453 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: To require certain insurers to provide notification of changes to their prescription drug coverage to all network health care providers, network pharmacies, network pharmacists, and insureds, and to specify when the change may apply.

Spectrum: Moderate Partisan Bill (Democrat 10-2)

Status: (Introduced - Dead) 2010-02-22 - To Health [HB453 Detail]

Download: Ohio-2009-HB453-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 453

Representative Boyd 

Cosponsors: Representatives Hagan, Harris, Yuko, Domenick, Weddington, Letson, Slesnick, Patten, Williams, S., Stewart, Oelslager 

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A BILL

To enact sections 1751.661, 3923.602, and 3923.611 of

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the Revised Code to require certain insurers to

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provide notification of changes to their

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prescription drug coverage to all network health

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care providers, network pharmacies, network

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pharmacists, and insureds, and to specify when the

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change may apply.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1751.661, 3923.602, and 3923.611 of	8
the Revised Code be enacted to read as follows:	9

Sec. 1751.661.  (A) No health insuring corporation shall	10
remove a prescription drug from its formulary, move a covered	11
prescription drug to a higher copay tier, interchange a	12
prescription drug, or add utilization management requirements for	13
a prescription drug without providing prior notice in writing to	14
all network health care providers, network pharmacies, network	15
pharmacists, and enrollees covered under any affected policy,	16
contract, or agreement. The notice shall specify that the change	17
will become effective as described in division (B) of this	18
section.	19

(B) Notwithstanding section 3901.71 of the Revised Code, if a	20
health insuring corporation makes any of the changes listed in	21
division (A) of this section, the change shall become effective on	22
the renewal date of the enrollee's policy, contract, or agreement.	23

(C) As used in this section:

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(1) "Formulary" means the list of prescription drugs covered	25
under the policy, contract, or agreement.	26

(2) "Interchange" means to substitute one version of a	27
prescribed drug for the drug originally prescribed including	28
substituting a generic version for a brand-name version, a	29
brand-name version for a generic version, a generic version by one	30
manufacturer or a generic version by a different manufacturer, a	31
different formulation of the same drug, or a different drug in the	32
same class.	33

Sec. 3923.602.  (A) No sickness and accident insurer shall	34
remove a prescription drug from its formulary, move a covered	35
prescription drug to a higher copay tier, interchange a	36
prescription drug, or add utilization management requirements for	37
a prescription drug without providing prior notice in writing to	38
all network health care providers, network pharmacies, network	39
pharmacists, and insureds covered under any affected policy of	40
sickness and accident insurance. The notice shall specify that the	41
change will become effective as described in division (B) of this	42
section.	43

(B) Notwithstanding section 3901.71 of the Revised Code, if a	44
sickness and accident insurer makes any of the changes listed in	45
division (A) of this section, the change shall become effective on	46
the renewal date of the insured's policy.	47

(C) As used in this section:

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(1) "Formulary" means the list of prescription drugs covered	49
under the policy.	50

(2) "Interchange" means to substitute one version of a	51
prescribed drug for the drug originally prescribed including	52
substituting a generic version for a brand-name version, a	53
brand-name version for a generic version, a generic version by one	54
manufacturer or a generic version by a different manufacturer, a	55
different formulation of the same drug, or a different drug in the	56
same class.	57

Sec. 3923.611.  (A) No public employee benefit plan shall	58
remove a prescription drug from its formulary, move a covered	59
prescription drug to a higher copay tier, interchange a	60
prescription drug, or add utilization management requirements for	61
a prescription drug without providing prior notice in writing to	62
all network health care providers, network pharmacies, network	63
pharmacists, and plan members covered under any affected public	64
employee benefit plan. The notice shall specify that the change	65
will become effective as described in division (B) of this	66
section.	67

(B) Notwithstanding section 3901.71 of the Revised Code, if a	68
public employee benefit plan makes any of the changes listed in	69
division (A) of this section, the change shall become effective on	70
the renewal date of the plan member's plan.	71

(C) As used in this section:

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(1) "Formulary" means the list of prescription drugs covered	73
under the plan.	74

(2) "Interchange" means to substitute one version of a	75
prescribed drug for the drug originally prescribed including	76
substituting a generic version for a brand-name version, a	77
brand-name version for a generic version, a generic version by one	78
manufacturer or a generic version by a different manufacturer, a	79
different formulation of the same drug, or a different drug in the	80
same class.	81