Ohio Revised Code Search

...(A) On and after July 1, 2027, no person shall solicit a plan or plan sponsor that is domiciled in this state or has its principal headquarters or principal administrative office in this state to act as a pharmacy benefit manager for the plan or plan sponsor unless licensed under this chapter. (B) No person shall provide pharmacy benefit management services pursuant to an agreement subject to this chapter unless li...

... application with the superintendent of insurance in the form and manner prescribed by the superintendent. The application shall include all the information the superintendent considers necessary to process the application, including evidence satisfactory to the superintendent that the applicant meets the requirements specified in division (C) of this section. (B) All applications for a pharmacy benefit manager lic...

...The superintendent of insurance shall approve or deny an application for a license under this chapter within a reasonable time after receipt.

...der this chapter, the superintendent of insurance shall notify the applicant of the denial and the reasons for the denial. The superintendent shall include a statement in the notice advising that the applicant is entitled to a hearing, in accordance with Chapter 119. of the Revised Code, if the applicant requests such a hearing within thirty days after receipt of the notice.

...iated filing fee, the superintendent of insurance shall grant the applicant a license to operate as a pharmacy benefit manager in this state. The initial license is effective on the date the application is approved by the superintendent and expires annually on the thirtieth day of June. If the initial license application is approved in May or June, the license expires on the thirtieth day of June the following year. ...

...(A) The superintendent of insurance shall provide a renewal notice to each licensee not later than the first day of May each year. (B) A licensee may renew its pharmacy benefit manager license by applying to the superintendent, in the form and manner prescribed by the superintendent, and paying a renewal fee of three thousand dollars before the date the license expires. A licensee shall not apply for a license rene...

...ate privacy laws, including the "Health Insurance Portability and Accountability Act of 1996," 42 U.S.C. 1320d, et seq. and the regulations adopted under that act. (D) A pharmacy benefit manager shall account, annually or more frequently, to the plan sponsor for any pricing discounts, rebates of any kind, inflationary payments, credits, claw backs, fees, grants, charge backs, drug product reimbursements, or other b...

...the Revised Code, the superintendent of insurance may take any of the actions enumerated in division (C) of this section if the superintendent finds that a licensee has done any of the following: (1) Violated any provision of this chapter, any rule adopted by the superintendent, or any consent agreement or order of the superintendent; (2) Provided incorrect, misleading, incomplete, or materially false information...

...ager shall notify the superintendent of insurance if the pharmacy benefit manager, or any owner of the pharmacy benefit manager, is subject to administrative action by a government entity having professional, occupational, or financial authority in this or another state while the pharmacy benefit manager holds a license under this chapter. The notice shall be provided not later than thirty days after the entry date o...

...ger and an insurer; (3) Fail to remit insurance premiums within the policy period or within the time agreed to in writing between the insurer and the pharmacy benefit manager; (4) Fail to disclose in writing the method of collecting and holding a plan sponsor's funds. (B) This section does not apply to the extent that it conflicts with an agreement that is not subject to this chapter.

...ter July 1, 2027, the superintendent of insurance may examine the relevant books and records described in division (A)(1) of this section of a pharmacy benefit manager as necessary to determine the following related to any contracts involving a pharmacy benefit manager and a plan sponsor of a health benefit plan or health plan issuer: (1) The aggregate amount of rebates received by a pharmacy benefit manager; (2)...

... data acquired by the superintendent of insurance or the department of insurance under this chapter is considered proprietary and confidential under section 3905.24 of the Revised Code and is not a public record under section 149.43 of the Revised Code. (B) On and after July 1, 2027, no pharmacy benefit manager or representative of a pharmacy benefit manager shall cause or knowingly permit the use of any advertisem...

...er does not apply to an employer's self-insurance program or fully insured plan to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes its application to such plan.

...the Revised Code, the superintendent of insurance shall comply with sections 3123.41 to 3123.50 of the Revised Code and any applicable rules adopted under section 3123.63 of the Revised Code with respect to a license issued pursuant to this chapter.

...at section. (E) The superintendent of insurance shall adopt rules as necessary to implement the requirements of this section.

...ing to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the plan. (3) "Pharmacy audit" has the same meaning as in section 3901.81 of the Revised Code. (B) No health plan issuer, pharmacy benefit manager, or any other administrator shall require cost-sharing in an amount, or direct a pharmacy to collect cost-sharing in an amount, greater than the less...

...No health plan issuer, pharmacy benefit manager, or any other administrator shall prohibit a pharmacy from mailing or delivering drugs to patients as an ancillary service.

...Whoever knowingly violates section 3957.03 of the Revised Code is guilty of a misdemeanor of the fourth degree.

...alth, prescription drugs, or disability insurance or self-insurance programs. "Administrator" includes a pharmacy benefit manager. "Administrator" does not include any of the following: (1) An insurance agent or solicitor licensed in this state whose activities are limited exclusively to the sale of insurance and who does not provide any administrative services; (2) Any person who administers or operates the wo...

...ll be licensed by the superintendent of insurance in accordance with rules adopted by the superintendent. (B) An administrator who has been licensed or certified by the state of the administrator's domicile under a statute or rule similar to sections 3959.01 to 3959.16 of the Revised Code shall, upon application, be licensed without testing, provided the state of domicile recognizes and grants licenses to administra...

...No person shall solicit a plan or sponsor of a plan to act as an administrator for, or provide administrative services to, a plan or sponsor of a plan that is either domiciled in this state or has its principal headquarters or principal administrative office in this state unless the person is duly licensed under sections 3959.01 to 3959.16 of the Revised Code.

...r shall file with the superintendent of insurance an application for a license on a form prescribed by the superintendent. (B) All applications for a license shall be accompanied by a nonrefundable filing fee of two hundred dollars per application made payable to the department of insurance. (C) All fees collected under this section and under section 3959.10 of the Revised Code shall be paid into the state treasury...

...The superintendent of insurance shall act on all applications submitted for a license within thirty days after receipt.

...If the superintendent of insurance denies the application for license, the superintendent shall promptly notify the applicant of the denial and the reasons for the denial within thirty days of the date the application is denied by the superintendent. The notice shall advise the applicant of the applicant's right to request a hearing within thirty days from the date of the mailing of the notice.

...nted a license by the superintendent of insurance and an appropriate certificate of authority to operate as an administrator will be issued to the applicant. The license shall be issued, effective on the date the application is approved by the superintendent or board, or both, for a term expiring on the following June 30. The license may be renewed annually for a period of one year commencing July 1.