OH SB265

Permits health insurers, sickness and accident insurers, and Medicaid to provide payment or reimbursement for services lawfully provided by pharmacists, including drug therapy management under consult agreements, immunizations, and drug administration under Chapter 4729 of the Revised Code.

Establishes step therapy protocol requirements for health insurers requiring protocols to use clinical review criteria based on clinical practice guidelines or medical or scientific evidence, and requires consideration of atypical patient populations and diagnoses.

Creates step therapy exemption processes requiring health insurers to provide prescribing providers a clear, easily accessible method to request exemptions, with decisions required within 48 hours for urgent care and 10 calendar days for other requests.

Grants step therapy exemptions when prescribed drugs are contraindicated, patient has tried the required drug without success, or patient is stable on current medication, with automatic approval if decisions are not made within required timeframes.

Applies to Medicaid managed care organizations and requires them to comply with step therapy and medication synchronization requirements, with the Medicaid Director submitting a state plan amendment within 90 days of the act's effective date.