S.B. No. 364 Summary

• Limits out-of-pocket cost sharing for specialty drugs treating rare diseases or serious conditions to a maximum of $150 per one-month supply for health insuring corporation policies and sickness/accident insurance policies.

• Defines "specialty drugs" as prescription drugs for rare diseases, progressive/debilitating conditions (including multiple sclerosis, hepatitis C, and rheumatoid arthritis), not stocked at most retail pharmacies, and requiring special handling or patient support.

• Requires health plans to establish a process allowing covered individuals to request coverage of specialty drugs not listed on preferred drug formularies, with denials subject to internal appeal and external review procedures.

• Prohibits health plans from placing all drugs in a given class on a specialty tier and does not require plans to cover additional drugs, implement specific utilization management techniques, or eliminate other cost-sharing strategies.

• Applies to policies, contracts, and arrangements delivered, issued, or renewed in Ohio on or after January 1, 2015; also amends requirements for multiple employer welfare arrangements operating group self-insurance programs.