173.811 Terms of manufacturer payment agreement.

(A) A manufacturer agreement entered into under section 173.81 of the Revised Code by a drug manufacturer and the department of aging shall include terms that do all of the following:

(1) Specify the time the agreement is to be in effect, which shall be not less than one year from the date the agreement is entered into;

(2) Specify which of the manufacturer’s drugs are included in the agreement;

(3) Permit the department to remove a drug from the agreement in the event of a dispute over the drug’s utilization;

(4) Require that the manufacturer specify a per unit amount that will be paid to the department for each drug included in the agreement that is dispensed to an Ohio’s best Rx program participant;

(5) Require that the per unit amount specified by the manufacturer be an amount that the manufacturer believes is greater than or comparable to the per unit amount generally payable by the manufacturer for the same drug when the drug is dispensed to an individual using the outpatient drug coverage included in a health benefit plan offered in this state or another state to public employees or retirees and the eligible dependents of those employees or retirees;

(6) Require the manufacturer to make payments in accordance with the amounts computed under division (A) of section 173.812 of the Revised Code;

(7) Require that the manufacturer make the payments on a quarterly basis or in accordance with a schedule established by rules adopted under section 173.83 of the Revised Code.

(B) For any drug included in a manufacturer agreement, the terms of the agreement may provide for the establishment of a process for referring Ohio’s best Rx program applicants and participants to a patient assistance program operated or sponsored by the manufacturer. The referral process may be included only if the manufacturer agrees to refer to the Ohio’s best Rx program residents of this state who apply but are found to be ineligible for the patient assistance program.

Effective Date: 07-01-2007