Ohio § 1753.21

§ 1753.21.

(A) If a policy, contract, or agreement of a health insuring corporation uses a restricted

formulary of prescription drugs, the health insuring corporation shall do both of

the following: (1) Develop such a formulary in consultation with and with the approval of a pharmacy

and therapeutics committee, a majority of the members of which are physicians or advanced

practice registered nurses affiliated with the health insuring corporation who may

prescribe prescription drugs and pharmacists affiliated with the health insuring corporation;

 or in consultation with and with the approval of a pharmacy and therapeutics committee

that is independent of the health insuring corporation consisting of physicians or

advanced practice registered nurses who may prescribe prescription drugs in their

state of licensure and pharmacists who are authorized to practice in their state of

licensure; (2) Establish a procedure by which an enrollee may obtain, without penalty or additional

cost sharing beyond that provided for formulary drugs under the enrollee's contract

with the health insuring corporation, coverage of a specific nonformulary drug when

the prescriber documents in the enrollee's medical record and certifies that the formulary

alternative has been ineffective in the treatment of the enrollee's disease or condition,

or that the formulary alternative causes or is reasonably expected by the prescriber

to cause a harmful or adverse reaction in the enrollee. (B) Nothing in this section shall be construed to require a health insuring corporation

to place any particular pharmaceutical product or therapeutic class of product on

any formulary, or to prohibit a health insuring corporation from restricting payments

for any specific pharmaceutical product or therapeutic class of product, including,

but not limited to, a requirement that the product be prescribed only by a defined

specialist or subspecialist.