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To enact sections 1751.661, 3923.602, and 3923.611 of | 1 |
the Revised Code to require certain insurers to | 2 |
provide notification of changes to their | 3 |
prescription drug coverage to all network health | 4 |
care providers, network pharmacies, network | 5 |
pharmacists, and insureds, and to specify when the | 6 |
change may apply. | 7 |
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: | 24 |
(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: | 48 |
(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: | 72 |
(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 |