Sub. H.B. No. 72 Summary

• Establishes requirements for step therapy protocols implemented by health plan issuers and the Ohio Department of Medicaid, requiring protocols be based on clinical practice guidelines or medical/scientific evidence.

• Requires health plan issuers and Medicaid to provide healthcare providers with clear, accessible processes to request step therapy exemptions, with decisions required within 48 hours for urgent care or 10 calendar days for other requests.

• Grants step therapy exemptions when the required drug is contraindicated per FDA labeling, patient has previously failed the required drug or an FDA-approved alternative, or patient is stable on a currently prescribed drug.

• Mandates health plan issuers make available to all providers a list of drugs subject to step therapy protocols, along with documentation requirements for exemption requests, on their websites or provider portals.

• Applies to health benefit plans delivered, issued, or renewed on or after January 1, 2020, and requires the Medicaid Director to submit a state plan amendment to the federal government within 90 days of enactment.