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Ohio is taking bold steps to reshape the pharmacy benefit landscape. In a significant move toward greater fairness, transparency and accountability, Ohio legislators introduced three companion bills—House Bill 229, Senate Bill 210 and House Bill 192—that could fundamentally change how Pharmacy Benefit Managers (PBMs) operate in the state. Detailed below are key features of the of the three bills.
A New Era of Oversight
Introduced in the House on April 9, 2025, and in the Senate on June 3, 2025, these bills aim to establish a comprehensive regulatory framework for PBMs. If enacted, Ohio will join a growing number of states demanding greater oversight of PBM activities, ensuring that all players in the prescription drug supply chain are held to higher standards.
Key Objectives of the Legislation
The proposed framework is designed to:
- Enhance State-Level Control and Transparency: By bringing PBMs under direct regulatory scrutiny, Ohio seeks to shine a light on previously opaque business practices.
- Promote Fairness for Independent and Community Pharmacies: The bills aim to level the playing field, supporting local pharmacies and ensuring they're treated equitably.
- Increase Accountability for Insurers and Plan Sponsors: Clearer rules mean plan sponsors and insurers can better track PBM performance and rebate distribution.
Licensing and Conduct Requirements
Under the new legislation, all PBMs operating in Ohio would be required to obtain a license from the Superintendent of Insurance, accompanied by a $2,000 filing fee. This licensing process is more than a formality—it's a gateway to ongoing oversight and accountability.
The bills also target unfair PBM practices. Notably, PBMs would be prohibited from reimbursing independent pharmacies at rates lower than those paid to their own affiliate pharmacies for the same services. This provision is designed to prevent anti-competitive behavior and protect independent pharmacies from discriminatory payment structures.
Transparency Through Documentation
Transparency is at the heart of these reforms. PBMs would be required to maintain comprehensive rebate documentation, including:
- The total rebates received and distributed;
- Amounts passed on to enrollees at the point of sale;
- Detailed breakdowns of payments to and from health care payors and pharmacies.
The Superintendent of Insurance would have the authority to examine and audit PBM records at any time, ensuring ongoing compliance.
Protecting Pharmacy Network Participation
House Bill 192 adds another layer of protection for Ohio pharmacies. Under this bill:
- Network Fairness: Health plan issuers offering or administering plans with pharmacy services cannot require pharmacies to meet accreditation or certification standards that differ from or exceed those set by the Ohio State Board of Pharmacy. This provision protects pharmacies from being excluded through burdensome or inconsistent requirements.
- Enforcement Mechanism: Any pharmacy or covered person harmed by a violation of this section can file a formal complaint with the Superintendent of Insurance, adding a practical tool for holding health plan issuers accountable.
New Anti-Retaliation Protections for Pharmacies
A critical addition to these reforms is the explicit prohibition on PBM retaliation against pharmacies that report violations or exercise their rights under the law. Under these provisions, PBMs are prohibited from retaliating against a pharmacy by:
- Terminating or refusing to renew a contract with the pharmacy without providing at least ninety (90) days' advance notice.
- Subjecting a pharmacy to increased audits without giving at least ninety (90) days' advance notice and a detailed description of the reason for the audit.
- Failing to promptly pay a pharmacy in accordance with Ohio law.
If a pharmacy in Ohio believes it has been retaliated against or that a PBM has otherwise violated these sections, the pharmacy may file a formal complaint and provide evidence to the Superintendent of Insurance. The Superintendent is empowered to adopt rules for implementing and administering these protections, and any regulatory restrictions adopted are exempt from certain state regulatory limitation statutes, ensuring robust enforcement.
Enforcement With Teeth
Should a PBM violate any provision of the new law, the Superintendent of Insurance can issue a written notice requiring correction within sixty days. This swift enforcement mechanism underscores Ohio's commitment to real, actionable oversight.
What Does This Mean for Ohio Pharmacies and Plan Sponsors?
If enacted, these reforms will:
- Create a more transparent, equitable and competitive pharmacy benefit environment.
- Give independent and community pharmacies new tools to challenge unfair practices and protect themselves from retaliation.
- Provide plan sponsors and insurers with clearer oversight and accountability measures.
- Empower patients and pharmacies to seek redress through formal complaints.
What's Next?
As these bills move through the legislative process, pharmacies, insurers and plan sponsors should stay informed and prepare for a new regulatory environment. Ohio's PBM reforms promise a more transparent, equitable and accountable marketplace—good news for patients, providers and payors alike.
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