H.B. 443 Summary

• Establishes requirements for step therapy protocols used by health plan issuers and the Ohio Department of Medicaid to restrict prescription drug coverage based on a specific treatment sequence.

• Requires clinical review criteria underlying step therapy protocols to be developed by independent expert panels, based on high-quality evidence, created through transparent processes that minimize bias, and continually updated.

• Mandates health plan issuers and Medicaid submit proposed clinical review criteria to the superintendent of insurance for approval before implementation.

• Requires clear and convenient exemption processes allowing patients and prescribers to request step therapy overrides when protocols are contraindicated, ineffective, previously failed, not medically appropriate, or when patients are stable on alternative drugs.

• Applies to health benefits plans and Medicaid starting January 1, 2016, with annual reporting requirements on exemption requests.