News & Advocacy

PBM Bill Continues To Make Progress In Ohio Legislature

posted: September 26, 2018

A bill seeking to reform PBM practices passed through the Ohio House earlier this summer and has been introduced in the Senate. House Bill 479 would prohibit the practice of PBMs requiring pharmacists to charge patients an amount greater than the pharmacy’s cash price for a particular prescription drug. The bill would also prohibit “gag clauses” that some PBMs place in pharmacy contracts that penalize pharmacists for discussing important information about a drug’s cost with patients.

Earlier this year, the Ohio Department of Insurance (ODI) issued a bulletin which effectively prohibited PBMs or health insurers from:

• Prohibiting any person, directly or indirectly, from informing, by any means, an individual about less expensive ways to purchase prescription drugs that may also be available under any insurance policy or benefit plan.
• Requiring cost-sharing in an amount, or directing a pharmacy to collect cost-sharing in an amount, greater than the amount an individual would pay for the prescription drug if the drug were purchased without coverage under a health benefit plan.

Although the bulletin accomplished much of what House Bill 479 set out to do, passing House Bill 479 remains just as important. House Bill 479 will codify the changes in the bulletin and also addresses a PBM’s ability to clawback funds from a pharmacy arbitrarily. The OAR government affairs team will continue to monitor this legislation and will provide updates as needed.