Ohio § 3923.85

§ 3923.85.

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

and accident insurance or a public employee benefit plan according to any coverage

limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements

imposed by the policy or plan. (B) Notwithstanding section 3901.71 of the Revised Code and subject to division (D) of this section, no individual or group policy of sickness

and accident insurance that is delivered, issued for delivery, or renewed in this

state and no public employee benefit plan that is established or modified in this

state shall fail to comply with either of the following: (1) The policy or plan 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 or plan 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, a policy or plan shall

be deemed to be in compliance with this section if the cost sharing imposed under

such a policy or plan 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)(1) The prohibitions in division (B) of this section do not preclude an individual or

group policy of sickness and accident insurance or public employee benefit plan from

requiring an insured or plan member to obtain prior authorization before orally administered

cancer medication is dispensed to the insured or plan member. (2) Division (B) of this section does not apply to the offer or renewal of any individual

or group policy of sickness and accident insurance that provides coverage for specific

diseases or accidents only, or to any hospital indemnity, medicare supplement, disability

income, or other policy that offers only supplemental benefits. (E) An insurer that offers any sickness and accident insurance or any public employee

benefit plan 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 insurer or plan 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 insurer or plan'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 insurer or plan 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

insurer or plan 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 insurer or plan'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 insurer or plan 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.