OH SB243

Requires health plan issuers and utilization review organizations implementing step therapy protocols to use clinical review criteria developed and endorsed by independent, multidisciplinary panels of experts based on high-quality studies and research.

Mandates that clinical review criteria be created through explicit and transparent processes that minimize bias, explain treatment options and outcomes, rate evidence quality, and consider patient subgroups and preferences.

Establishes a clear and convenient exemption process allowing patients and prescribers to request step therapy exemptions based on contraindications, expected ineffectiveness, previous treatment failures, medical inappropriateness, or patient stability on current medications.

Requires health plan issuers to certify annually to the superintendent of insurance that step therapy protocols meet statutory requirements and to submit proposed clinical review criteria for approval before implementation.

Applies the same requirements to the Department of Medicaid for step therapy protocols in the Medicaid program, effective January 1, 2016.