H.B. 399 Summary: Ohio Right to Shop Act

• Requires health care providers to furnish written cost estimates to patients before non-emergency services, including total charges, expected insurance payment, and patient responsibility, with estimates due within 24 hours of appointment scheduling.

• Mandates health plan issuers create websites for providers to submit service information and for patients to obtain cost estimates and compare prices among network providers, with estimates generated within 5 minutes.

• Establishes shared savings incentive programs requiring health insurers to provide payments to insured individuals equal to at least 50% of savings when they use health care providers charging less than the issuer's average price for shoppable services (physical therapy, imaging, laboratory, surgical procedures, etc.).

• Restricts prior authorization requirements by exempting top-performing prescribers, eliminating authorization for drugs/services costing $100 or less, prohibiting step therapy protocols when patients have previously failed lower-step treatments, and requiring standardized prior authorization forms.

• Creates enforcement mechanisms allowing the superintendent of insurance and regulatory boards to impose fines up to $100,000-$300,000 for consistent pattern violations, and requires annual reporting to the legislature on shared savings program participation and payments.