Sometimes, as part of the legislative process, the initially-introduced version of legislation is replaced by a substitute version, and/or is amended after the further collaboration and deliberation of interested parties.
This can be necessary in order for the proposed legislation to obtain the necessary support to move forward. Rep. Kevin Miller (R-Newark), the sponsor of House Bill 130, has been working with physician groups and other interested parties on a substitute bill, and it was accepted in February. This represents progress for this high priority bill after months of work in the background, including deliberation with the health plans.
As a reminder, House Bill 130, if passed, will create a Prior Authorization Gold Card program in Ohio, where providers who consistently adhere to evidence-based medicine will be exempted from certain prior authorization requirements. The changes made in the substitute version of the bill will retain meaningful change to reduce the burden of prior authorization for physicians across the state, while lessening the opposition to the bill from the insurance industry and making its path through the legislature smoother.
House Bill 291 – Non-Medical Switching
On a similar note, in response to strong opposition from the health plans, an amendment to HB 291, which would prohibit health plans from engaging in the practice of non-medical switching, was also accepted. Non-medical switching occurs when health plan issuers or pharmacy benefit managers (PBMs) force patients to switch from a medication they rely on to treat their condition to a different medication (that is potentially less effective), for a non-medical reason.
The original version of the bill sought to ban non-medical switching outright, but the amended version allows for potential changes by the insurer if the cost of a medication increases by 5% or higher in calendar year. This compromise should help this legislation advance, without losing the overall impact of the bill on improving patient care. HB 291, if passed, would still prevent non-medical switching in the majority of circumstances faced by patients.
House Bill 177 – Co-pay Accumulator
House Bill 177, legislation dealing with co-pay accumulator policies, passed out of the Ohio House Public Health Policy Committee in late 2023. Health plans and pharmacy benefit managers (PBMs) may apply co-pay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap.
This legislation which would require insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket cost will be reintroduced this year. Passage of this bill is essential to increasing predictability as vulnerable patients face high out-of-pocket costs for their prescriptions.