Signed by Governor Mike DeWine

Vote Smart's Synopsis:

Prohibits Pharmacy Benefit Managers and insurers from imposing additional charges or reducing reimbursements on those discounted drugs.

Highlights:

• Defines "state maximum allowable cost" as the per unit amount the medicaid program pays a terminal distributor of dangerous drugs for a prescribed drug included in the state maximum allowable cost program (Sec. 1-5164.751).

• Prohibits health plan issuers or third-party administrators from making payments pursuant to a health benefit plan and discriminating against a 340B covered entity in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from a 340B covered entity or its contracted pharmacies (Sec. 1-3902.51.B).

• Requires the Medicaid director to establish a state maximum allowable cost program for purposes of managing medicaid payments to terminal distributors of dangerous drugs for prescribed drugs identified by the director pursuant to this division. The director shall do all of the following with respect to the program (Sec. 1-5164.751.):

• Identify and create a list of prescribed drugs to be included in the program;

• Update the list of prescribed drugs described in division (B)(1) of this section on a weekly basis; and

• Review the state maximum allowable cost for each prescribed drug included on the list described in division B1 of this section on a weekly basis.

• Prohibits any contract between a medicaid managed care organization, including a third-party administrator, and a 340B covered entity from containing any of the following provisions (Sec. 1-5167.123):

• A payment rate for a prescribed drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug;

• A fee that is not imposed on a health care provider that is not a 340B covered entity; and

• A fee amount that exceeds the amount for a health care provider that is not a 340B covered entity.

Full Bill Text