Ohio requires drug benefit manager licenses starting July 2027

Prescription drug benefit managers must obtain an Ohio license for covered work. Covered work includes seeking business from plans based in Ohio and serving agreements entered into, amended, or renewed on or after July 1, 2027. Applicants must meet background and business requirements. Out-of-state applicants may seek a nonresident license if their home state offers Ohio applicants the same treatment. Employer health plans are exempt from licensing rules to the extent federal law prevents their application. Knowingly breaking these licensing requirements is a fourth-degree misdemeanor, a criminal offense. Licenses generally expire June 30. An initial license approved in May or June expires June 30 of the following year.

Drug benefit managers must use written contracts and disclose financial details and conflicts of interest to plan sponsors. Plan sponsors establish health plans. These duties cover services under agreements entered into, amended, or renewed on or after July 1, 2027. Contracts must explain services, payment rates, their length, and how they can be renewed or ended. Managers must disclose related arrangements with other parties and give sponsors access to financial and drug-use information. Managers must account for discounts, rebates, and other financial benefits at least annually and keep written agreements for five years after they end.

Drug benefit managers must document the money they handle, report to plan sponsors, and pay for state examinations of their records. Record and reporting duties cover agreements entered into, amended, or renewed on or after July 1, 2027. Managers must explain how they collect and hold sponsor funds and specify their uses in writing. These restrictions yield where they conflict with older agreements not since amended or renewed. Ohio’s insurance regulator may examine rebate and payment records. Information obtained under this chapter is confidential and is not a public record. Records remain for ten years after services end. Reports are due within 90 days of the plan’s fiscal year-end. Returned premiums or contributions must be refunded or credited within 30 days of receipt.

Ohio’s insurance regulator may investigate drug benefit managers and impose fines, license penalties, or orders to stop conduct. These powers cover licensed drug benefit managers and people suspected of conduct addressed by the law. Fines and license penalties require notice and a hearing. Grounds include listed misconduct or the regulator’s judgment about the public’s, insurers’, and plan sponsors’ interests. Managers must report government disciplinary actions and criminal cases involving themselves or their owners, except misdemeanor traffic offenses. Starting July 1, 2027, managers cannot cause or knowingly allow false, deceptive, or misleading advertising or offers. Stop orders take effect upon receipt of notice, with a hearing scheduled within 15 days of the order. Reports are due within 30 days of entry of a final disciplinary outcome, the first criminal court appearance, and the final criminal outcome.