Ohio § 3923.60

§ 3923.60.

(A) Notwithstanding section 3901.71 of the Revised Code , no group or individual policy of sickness and accident insurance that provides coverage

for prescription drugs shall limit or exclude coverage for any drug approved by the

United States food and drug administration on the basis that the drug has not been

approved by the United States food and drug administration for the treatment of the

particular indication for which the drug has been prescribed, provided the drug has

been recognized as safe and effective for treatment of that indication in one or more

of the standard medical reference compendia adopted by the United States department

of health and human services under 42 U.S.C. 1395x(t)(2) , as amended, or in medical literature that meets the criteria specified in division

(B) of this section. (B) Medical literature may be accepted for purposes of division (A) of this section only

if all of the following apply: (1) Two articles from major peer-reviewed professional medical journals have recognized,

based on scientific or medical criteria, the drug's safety and effectiveness for treatment

of the indication for which it has been prescribed; (2) No article from a major peer-reviewed professional medical journal has concluded,

based on scientific or medical criteria, that the drug is unsafe or ineffective or

that the drug's safety and effectiveness cannot be determined for the treatment of

the indication for which it has been prescribed; (3) Each article meets the uniform requirements for manuscripts submitted to biomedical

journals established by the international committee of medical journal editors or

is published in a journal specified by the United States department of health and

human services pursuant to section 1861(t)(2)(B) of the “Social Security Act,” 107

Stat. 591 (1993), 42 U.S.C. 1395x(t)(2)(B) , as amended, as acceptable peer-reviewed medical literature. (C) Coverage of a drug required by division (A) of this section includes medically necessary

services associated with the administration of the drug. (D) Division (A) of this section shall not be construed to do any of the following: (1) Require coverage for any drug if the United States food and drug administration has

determined its use to be contraindicated for the treatment of the particular indication

for which the drug has been prescribed; (2) Require coverage for experimental drugs not approved for any indication by the United

States food and drug administration; (3) Alter any law with regard to provisions limiting the coverage of drugs that have

not been approved by the United States food and drug administration; (4) Require reimbursement or coverage for any drug not included in the drug formulary

or list of covered drugs specified in a policy of sickness and accident insurance; (5) Prohibit a policy of sickness and accident insurance from limiting or excluding coverage

of a drug, provided that the decision to limit or exclude coverage of the drug is

not based primarily on the coverage of drugs required by this section. (E) This section, as amended, applies only to policies of sickness and accident insurance

that are described in division (A) of this section and that are delivered, issued

for delivery, or renewed in this state on or after the effective date of this amendment.