Bill
HB 915
The bill requires coverage of epinephrine and glucagon for youths 18 and under and caps out-of-pocket costs at $60 per two autoinjectors or equivalent dose.
HB 915 (Bill No. 915, 136th General Assembly, Ohio) aims to expand access to emergency medications for children and teens and to establish uniform cost-sharing limits. The bill would require coverage of epinephrine and glucagon for individuals 18 years and younger by health benefit plans and the Medicaid program, and it sets maximum cost-sharing for these medications. It also makes related adjustments to Medicaid cost-sharing rules and to certain prescription drug management provisions for Medicaid managed care organizations.
1) Epinephrine and glucagon coverage for youths
- Defines epinephrine autoinjector and glucagon autoinjector.
- Health plans issued, amended, or renewed after the effective date must cover:
- Epinephrine in any prescribed form (medically necessary, as determined by the provider).
- Glucagon in any prescribed form (medically necessary, as determined by the provider).
- Cost-sharing cap for autoinjectors: no more than $60 per package containing two autoinjectors, regardless of quantity needed.
- Cost-sharing cap for non-autoinjector forms: no more than $60 per dose equivalent to the amount in two autoinjectors.
- Caps apply regardless of other cost-sharing requirements (deductibles, copays, coinsurance).
- Plans may reduce cost-sharing below these caps.
2) Medicaid cost-sharing framework (Sections 5162.20 and 5164.094)
- Medicaid must institute cost-sharing requirements that do not disproportionately burden recipients with chronic illnesses or violate existing state law.
- Prohibits providers from refusing service to a Medicaid recipient who cannot pay a copayment, with limited exceptions (e.g., hospitals may pursue certain collection actions if they provide notice and choose to pursue collection).
- Prohibits providers and drug manufacturers from waiving copayments on behalf of recipients.
- Hospitals may collect copayments at the point of service but must provide notice if they choose not to pursue further collection actions.
- Allows the Medicaid department to collaborate with state agencies to apply cost-sharing requirements across components of the program.
3) Medicaid drug management and MCOs (Section 5167.12)
- Allows MCOs to implement drug utilization strategies under approval, with restrictions against requiring prior authorization for certain antidepressants/antipsychotics under specified conditions.
- Permits pharmacy utilization management that may require prior authorization for controlled substances.
- Requires compliance with related cost-sharing and program sections.
Note: This summary reflects the introduced language and may be subject to amendments during the legislative process.
Compiled from official sources — confirm details with the bill’s official record.
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