Ohio § 1751.69

§ 1751.69.

(A) As used in this section, “ cost sharing ” means the cost to an individual insured under an individual or group health insuring

corporation policy, contract, or agreement according to any coverage limit, copayment,

coinsurance, deductible, or other out-of-pocket expense requirements imposed by the

policy, contract, or agreement. (B) Notwithstanding section 3901.71 of the Revised Code and subject to division (D) of this section, no individual or group health insuring

corporation policy, contract, or agreement providing basic health care services or

prescription drug services that is delivered, issued for delivery, or renewed in this

state, if the policy, contract, or agreement provides coverage for cancer chemotherapy

treatment, shall fail to comply with either of the following: (1) The policy, contract, or agreement shall not provide coverage or impose cost sharing

for a prescribed, orally administered cancer medication on a less favorable basis

than the coverage it provides or cost sharing it imposes for intraveneously 1 administered or injected cancer medications. (2) The policy, contract, or agreement shall not comply with division (B)(1) of this

section by imposing an increase in cost sharing solely for orally administered, intravenously

administered, or injected cancer medications. (C) Notwithstanding any provision of this section to the contrary, an individual or group

health insuring corporation policy, contract, or agreement shall be deemed to be in

compliance with this section if the cost sharing imposed under such a policy, contract,

or agreement for orally administered cancer treatments does not exceed one hundred

dollars per prescription fill.  The cost sharing limit of one hundred dollars per prescription fill shall apply

to a high deductible plan, as defined in 26 U.S.C. 223 , or a catastrophic plan, as defined in 42 U.S.C. 18022 , only after the deductible has been met. (D) The prohibitions in division (B) of this section do not preclude an individual or

group health insuring corporation policy, contract, or agreement from requiring an

enrollee to obtain prior authorization before orally administered cancer medication

is dispensed to the enrollee. (E) A health insuring corporation that offers coverage for basic health care services

is not required to comply with division (B) of this section if all of the following

apply: (1) The health insuring corporation submits documentation certified by an independent

member of the American academy of actuaries to the superintendent of insurance showing

that compliance with division (B)(1) of this section for a period of at least six

months independently caused the health insuring corporation's costs for claims and

administrative expenses for the coverage of basic health care services to increase

by more than one per cent per year. (2) The health insuring corporation submits a signed letter from an independent member

of the American academy of actuaries to the superintendent of insurance opining that

the increase in costs described in division (E)(1) of this section could reasonably

justify an increase of more than one per cent in the annual premiums or rates charged

by the health insuring corporation for the coverage of basic health care services. (3)(a) The superintendent of insurance makes the following determinations from the documentation

and opinion submitted pursuant to divisions (E)(1) and (2) of this section: (i) Compliance with division (B)(1) of this section for a period of at least six months

independently caused the health insuring corporation's costs for claims and administrative

expenses for the coverage of basic health care services to increase more than one

per cent per year. (ii) The increase in costs reasonably justifies an increase of more than one per cent

in the annual premiums or rates charged by the health insuring corporation for the

coverage of basic health care services. (b) Any determination made by the superintendent under division (E)(3) of this section

is subject to Chapter 119. of the Revised Code. 1

 So in original.