HB 699: Require prescription drug coverage by health plan issuers

Representatives Abdullahi, Lett
Cosponsors: Representatives Piccolantonio, Rader, McNally, Brennan, Brent, Sims

Sec. 3902.65. (A) Notwithstanding section 3901.71 of the Revised Code, a health benefit plan delivered, issued for delivery, modified, or renewed on or after January 1, 2027, that covers prescription drugs shall cover any drug product prescribed to treat a covered person for a disease, disorder, or condition if all the following are met:

1. The drug has been approved by the United States food and drug administration for the covered person's disease, disorder, or condition.
2. The drug is recognized by either of the following for treatment of the covered person's disease, disorder, or condition:
   1. A prescription drug reference compendium approved by the superintendent of insurance for the purposes of this section;
   2. Substantially accepted peer-reviewed medical literature.
3. Coverage for the disease, disorder, or condition is not expressly excluded under the plan.

(B) The coverage required by division (A) of this section shall include all medically necessary services associated with the administration of the prescription drug.

(C) A health plan issuer shall not, based on a "medical necessity" requirement, deny coverage of a prescription drug unless the reason for the denial is unrelated to the legal status of the drug use.

(D) This section does not require a health benefit plan to cover either of the following:

1. Experimental drugs that are not otherwise approved for treating the covered person's disease, disorder, or condition by the United States food and drug administration;
2. A drug that the United States food and drug administration has determined to be contraindicated for treatment of the covered person's disease, disorder, or condition.