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Bill

HB 890

Enact Prescription Relief, Inflation Cost Elimination (PRICE) Act

136th Legislature (2025-2026) Introduced by Sean Brennan and 5 co-sponsors

Ohio creates a Prescription Drug Affordability Board to review drug costs and set upper payment limits for high-cost drugs to curb patient and payer expenses.

Referred to committee
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Bill Summary · HB 890

Executive summary

HB 890, introduced in the 136th Ohio General Assembly, proposes creating the Prescription Drug Affordability Board and the Prescription Drug Affordability Stakeholder Council, establishing upper payment limits on certain prescription drugs, repealing the existing Prescription Drug Transparency and Affordability Advisory Council, and naming the measure the Prescription Relief and Inflation Cost Elimination or P.R.I.C.E. Act. The core aim is to monitor drug prices, review affordability, and set upper payment limits to curb high costs for patients, payers, and hospitals.

Purpose and intent

  • Establish a formal, independent mechanism to oversee prescription drug affordability in Ohio.
  • Identify drugs with affordability concerns and, when appropriate, set upper payment limits to control costs for purchasers and third-party payers.
  • Replace the current advisory framework with a dedicated board and stakeholder council to guide, review, and implement affordability measures.
  • Improve transparency and accountability in drug pricing and its impact on patients, health plans, and providers.

Key provisions and changes

  • Creation of two new entities:
    • Prescription Drug Affordability Board (in the Department of Insurance)
    • Prescription Drug Affordability Stakeholder Council (in the Department of Insurance)
  • Definitions (Sec. 3901.85) to align with terms such as brand name drug, generic drug, biosimilar, 340B entities, wholesale acquisition cost (WAC), and third-party payers.
  • Board composition and governance (Sec. 3901.851):
    • Nine members appointed by the governor and confirmed by the Senate.
    • Expertise in health care economics, policy, equity, and clinical medicine; at least one patient advocate.
    • Prohibition on conflicts with drug manufacturers or trade associations.
    • Terms: initial four 1-year terms and five 2-year terms; subsequent four-year terms.
    • Compensation and travel reimbursement for members; board meets at least four times per year.
    • Public records rules with confidentiality for trade secrets.
  • Stakeholder Council (Sec. 3901.853):
    • 23 members, including state agency officials, health care providers, manufacturers (brand and generic), employers, PBMs, pharmacists, physicians, nurses, hospitals, managed care organizations, researchers, and advocacy groups.
    • Appointments by the governor; focus areas include pharmaceutical business models, patient perspectives, cost trends, and research.
    • Initial terms of varying lengths (1, 2, or 3 years) to stagger membership; subsequent terms three years.
    • No compensation for council members but travel expense reimbursement.
    • Meetings: at least four times per year; public records with confidential information protected.
  • Operational and rulemaking authorities (Sec. 3901.852):
    • Board may contract with independent third parties with confidentiality protections.
    • Board to adopt rules under established Ohio rulemaking procedures.
  • Drug product review and price controls (Sec. 3901.854 to 3901.855):
    • Starting 18 months after enactment, the board (in consultation with the council) will select one or more prescription drug products for review based on criteria including high inflation-adjusted WAC, large price increases, biosimilar price gaps, high generic WAC, and affordability concerns for hospitals or patients.
    • Not all drugs meeting criteria must be reviewed; the board decides on cost and affordability reviews.
    • Reviews consider multiple factors: WAC, rebates/discounts to plans, prices of alternatives, patient cost sharing, hospital access, and other factors established by rule.
    • If a drug is deemed to cause affordability challenges, the board may establish an upper payment limit (UPL).
    • UPL considerations include administrative stocking costs and impact on 340B entities.
    • UPL exclusions: professional dispensing fees; drugs currently in FDA shortage.
    • If cost-effectiveness analysis is used, it must avoid age/illness-based subpopulation bias and use equal lifetime value across individuals.
    • UPL takes effect on a date set by the board, not earlier than six months after establishment.
  • Payment and reimbursement (Sec. 3901.855):
    • Once a UPL is established, purchasers/third-party payers cannot purchase, bill, or reimburse above the limit.
    • Detailed exceptions: independent pharmacies, hospital pharmacies, hospitals (including behavioral health), and 340B entities may not be reimbursed below the UPL.
  • Enforcement and appeals (Sec. 3901.856):
    • AG may investigate violations and file civil actions for enforcement; decisions may be appealed under existing rules.
  • Funding (Sec. 3901.857):
    • Establishment of the Prescription Drug Affordability Fund in the state treasury.
    • All money appropriated or collected for administration goes to this fund; investment earnings also accrue here.
    • The Department of Insurance uses the fund to support the Board and Council.
  • Annual reporting (Sec. 3901.858):
    • By December 31 each year, the Board must report price trends, reviews conducted, outcomes of appeals, and legislative recommendations; report submitted per existing reporting requirements.
  • Repeal of existing framework (Section 2):
    • Repeals Section 125.95 of the Revised Code, effectively removing the current Prescription Drug Transparency and Affordability Advisory Council.
  • Generic drugs market review (Section 3):
    • The Board must review the U.S. generic drug market within 12 months of the act’s effective date, addressing prices, premium impacts, cost sharing, shortages, Medicaid impacts, and 340B effects.
    • Findings to be reported to the General Assembly.

Who would be affected

  • Prescription drug manufacturers and brand/generic drug suppliers (subject to review and potential UPLs).
  • Health benefit plans, insurers, and third-party payers (limits on reimbursements and potential added compliance).
  • Hospitals, hospital pharmacies, and 340B-covered entities (subject to UPLs but protected in certain reimbursement scenarios).
  • Independent pharmacies and patient-access programs (protected in specified payment scenarios).
  • Pharmacists, physicians, nurses, and other health care providers (indirectly affected through affordability and access decisions).
  • Patients and consumer advocates (potentially benefiting from lower out-of-pocket costs and improved access).
  • Government agencies (Department of Insurance, Medicaid, Department of Health policy input) and public budgeting via the Prescription Drug Affordability Fund.

Procedural and timeline notes

  • Enactment triggers a phased implementation:
    • 18 months after enactment: board/council select initial drugs for review.
    • Six months after UPL establishment: UPLs take effect for purchases/payments.
  • Initial governance terms and staggered appointments aim to ensure continuity.
  • Reports required annually to the General Assembly; generic drug market review due within one year of effective date.
  • Rules and confidentiality protections are to be established under standard Ohio rulemaking procedures.

Overall assessment

The bill constructs a dedicated governance and oversight framework aimed at curbing prescription drug cost growth in Ohio by identifying high-impact drugs, evaluating affordability, and setting upper payment limits where appropriate. It emphasizes transparency, stakeholder input, and careful consideration of public payer and hospital impacts, while safeguarding confidentiality for sensitive information and avoiding certain limits that could undermine dispensing or essential shortages.

Compiled from official sources — confirm details with the bill’s official record.

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