Ohio § 3902.72

§ 3902.72.

(A) As used in this section, “health care provider” has the same meaning as in section 3701.74 of the Revised Code . (B) A health plan issuer, including a pharmacy benefit manager, shall, upon request of

a covered person, the covered person's health care provider, or the third-party representative,

furnish the following data for any and all drugs covered under a related health benefit

plan: (1) The covered person's eligibility information for any and all covered drugs; (2) Cost-sharing information for any and all covered drugs, including a description of

any variance in cost-sharing based on pharmacy, whether retail or mail order, or health

care provider dispensing or administering the drugs; (3) Any applicable utilization management requirements for any and all covered drugs,

including prior authorization requirements, step therapy, quantity limits, and site-of-service

restrictions. (C) A health plan issuer, including a pharmacy benefit manager, providing the data required

under division (B) of this section shall ensure that the data meets all of the following: (1) It is current not later than one business day after any change is made. (2) It is provided in real time. (3) It is provided in the same format that the request is made by the covered person,

the covered person's health care provider, or the third-party representative. (D) The format in which a health plan issuer, including a pharmacy benefit manager, replies

to a request made under division (B) of this section shall use established industry

content and transport standards published by either of the following: (1) A standards developing organization accredited by the American national standards

institute, including the national council for prescription drug programs, ASC X12,

health level 7; (2) A relevant federal or state governing body, including the centers for medicare and

medicaid services or the office of the national coordinator for health information

technology. (E) A health plan issuer, including a pharmacy benefit manager, shall furnish the data

required under division (B) of this section regardless of whether the request is made

using the drug's unique billing code, such as a national drug code or health care

common procedure coding system code, or a descriptive term, such as the brand or generic

name of the drug. (F) A health plan issuer, including a pharmacy benefit manager, shall not deny or delay

a request as a method of blocking the data required under division (B) of this section

from being shared based on how the drug was requested. (G) A health plan issuer, including a pharmacy benefit manager, furnishing the data required

under division (B) of this section shall not do any of the following: (1) Restrict, prohibit, or otherwise hinder, in any way, a health care provider from

communicating or sharing any of the following: (a) Any of the data required under division (B) of this section; (b) Additional information on any lower-cost or clinically appropriate alternatives,

whether or not they are covered under the covered person's health benefit plan; (c) Additional payment or cost-sharing information that may reduce the covered person's

out-of-pocket costs, such as cash price or patient assistance and support programs

whether sponsored by a manufacturer, foundation, or other entity. (2) Except as may be required by law, interfere with, prevent, or materially discourage

access, exchange, or use of the data required under division (B) of this section,

including any of the following: (a) Charging fees; (b) Not responding to a request at the time the request is made, if such a response is

reasonably possible; (c) Implementing technology in nonstandard ways; (d) Instituting covered person consent requirements, processes, policies, procedures,

or renewals that are likely to substantially increase the complexity or burden of

accessing, exchanging, or using such data. (3) Penalize a health care provider for disclosing such data to a covered person or for

prescribing, administering, or ordering a clinically appropriate or lower-cost alternative. (H)(1) A health plan issuer, including a pharmacy benefit manager, shall treat a personal

representative of a covered person as the covered person for purposes of this section. (2) If under applicable law a person has authority to act on behalf of a covered person

in making decisions related to health care, a health plan issuer, including a pharmacy

benefit manager, or its affiliates or entities acting on its behalf, shall treat such

person as a personal representative under this section. (I) Divisions (A) to (H) of this section take effect January 1, 2022.