To amend sections 1751.12 and 1751.32 and to enact sections 3923.811 and 3959.21 of the Revised Code to prohibit certain health insurance cost-sharing practices.
HB937 would revise Ohio insurance law to limit certain health plan cost-sharing practices and to regulate how prescription drug assistance is treated in benefit design. The bill amends existing provisions governing health insuring corporations and adds new sections applicable to sickness and accident insurers and pharmacy benefit managers. It requires cost sharing, copayments, coinsurance, and deductibles to stay within federal annual out-of-pocket limits, bars insurers from designing coverage based on the availability or amount of manufacturer or other financial assistance for prescription drugs, and generally requires amounts paid by third parties on an enrollee’s behalf to count toward the enrollee’s cost-sharing obligations.
The bill also creates reporting and certification requirements. Health insuring corporations, sickness and accident insurers, and pharmacy benefit managers would have to certify annually to the superintendent of insurance that they complied with the new requirements. For health insuring corporations, the bill also tightens filing and review rules for premium rates and requires administrative expense portions of filings to reflect actual administrative costs. The changes would apply to health benefit plans delivered, issued, modified, or renewed on or after January 1, 2027.
HB937 would expand the superintendent of insurance’s oversight of health plan pricing and cost-sharing practices, while adding new compliance obligations for insurers and pharmacy benefit managers. It would amend sections 1751.12 and 1751.32 of the Revised Code and enact new sections 3923.811 and 3959.21, affecting health insuring corporations, sickness and accident insurers, and PBMs. The bill would also interact with federal rules on high-deductible health plans and health savings accounts, preserving certain federal tax-qualification protections and exceptions for preventive care and some generic-drug situations.
The bill appears to be framed as a consumer-protection measure aimed at making out-of-pocket costs more predictable and preventing insurers from using prescription drug assistance to influence coverage design. Because the bill was only introduced and there are no committee transcripts or recorded votes in the provided materials, there is no documented legislative debate or vote-based sentiment to assess. Based on the text alone, the policy direction is generally pro-consumer and pro-transparency.
The main points of potential contention are likely to be the limits on insurer and PBM discretion in benefit design, the requirement to count third-party assistance toward cost sharing, and the prohibition on conditioning coverage on the availability of drug assistance. Insurers and pharmacy benefit managers may view these provisions as restricting plan design flexibility or complicating administration, while supporters would likely argue they prevent cost barriers and improve access to needed medications. Another possible issue is the interaction with high-deductible health plans and health savings accounts, since the bill includes carveouts to avoid jeopardizing federal tax treatment.