To amend section 3902.50 and to enact sections 3902.75, 3902.76, and 3959.151 of the Revised Code to limit insurer accreditation requirements for pharmacies, to implement drug cost reporting requirements for pharmacy benefit managers, and to name this act the Community Pharmacy Protection Act.
HB192, titled the Community Pharmacy Protection Act, would amend Ohio insurance law to restrict the accreditation or certification standards that health plan issuers may impose on pharmacies participating in their networks. Under the bill, a health plan issuer could not require a pharmacy to meet accreditation or certification standards that go beyond, or conflict with, standards set by the State Board of Pharmacy. The bill also allows covered persons and pharmacies to file complaints with the superintendent of insurance if they believe those requirements are being violated.
The bill further creates new pharmacy benefit manager (PBM) reporting requirements. PBMs would have to provide quarterly electronic reports, in machine-readable and plain-language formats, to the superintendent of insurance and to insurers, plan sponsors, and certain public and self-insured plans. Those reports would include itemized drug-claim data such as maximum allowable cost, actual acquisition cost, formulary status, and whether each drug is brand-name, generic, or specialty. The bill also prohibits newer PBM contracts from barring disclosure of that information and bars retaliation against pharmacies that report violations or exercise rights under the section.
HB192 would add new sections 3902.75, 3902.76, and 3959.151 to the Revised Code and amend section 3902.50, thereby expanding state oversight of pharmacy network participation and PBM pricing practices. It would give the superintendent of insurance enforcement authority, including complaint review, notice of violation, adjudication hearings, and a $1,000-per-violation administrative penalty that can accrue daily. The bill would apply to health benefit plans and pharmacy contracts entered into, modified, or renewed on or after the effective date, and it would direct penalty revenue to the department of insurance operating fund.
The bill appears to be framed positively toward independent and community pharmacies, as reflected in its title and sponsor lineup, and there is no recorded committee vote or transcript showing opposition or support beyond introduction. Its stated purpose suggests a pro-pharmacy, transparency-focused approach aimed at limiting insurer leverage and increasing PBM accountability. Because the bill has only been introduced and has not yet advanced through recorded votes or hearings in the provided materials, the overall sentiment in the available record is limited but leans supportive by design.
The main points of potential contention are likely to be between pharmacies and insurers/PBMs. Pharmacies and covered persons would likely support the bill’s limits on insurer accreditation demands, reporting transparency, and anti-retaliation protections, while health plan issuers and PBMs may object to the compliance burden, disclosure requirements, and new penalties. Another likely dispute is the bill’s treatment of existing PBM contracts: it preserves confidentiality for certain preexisting agreements, which may soften industry concerns but also creates a distinction between older and newer contracts. No formal committee debate or vote is available in the provided record, so these contentions are inferred from the bill’s structure and affected parties.