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Bill Summary · HB 699

Summary: HB 699 (136th General Assembly, Ohio)

Purpose and intent

  • Establishes a new requirement that health benefit plans with prescription drug coverage must cover any FDA-approved drug that is prescribed to treat a covered person’s disease, disorder, or condition, provided the drug is recognized for treatment and the plan does not expressly exclude coverage for that disease or condition.
  • Applies to plans delivered, issued for delivery, modified, or renewed on or after January 1, 2027.

Key provisions and changes

  • Eligibility of drugs for coverage
    A prescription drug must meet all three criteria to be mandatorily covered:

    1. The U.S. FDA has approved the drug for the covered person’s disease, disorder, or condition.
    2. The drug is recognized for treatment of that condition by either:
      • A prescription drug reference compendium approved by the Superintendent of Insurance for this section, or
      • Substantially accepted peer-reviewed medical literature.
    3. The plan does not expressly exclude coverage for the disease, disorder, or condition.

  • Coverage scope
    The requirement covers not only the drug itself but also all medically necessary services associated with administering the prescription drug.

  • Denying coverage
    Health plan issuers may not deny prescription drug coverage based on a “medical necessity” determination if the denial is unrelated to the legal status of drug use (i.e., not tied to whether the drug is legally prescribed or FDA-approved).

  • Exclusions
    The bill does not require coverage of:

    • Experimental drugs not FDA-approved for the condition.
    • Drugs that the FDA has determined are contraindicated for the condition.

  • Applicability and transition
    The mandate applies to plans issued, delivered, modified, or renewed on or after January 1, 2027.

  • Regulatory context and ERISA considerations
    The bill addresses potential conflicts with federal ERISA preemption. It includes language suggesting a pathway for applying the mandated benefit to ERISA-regulated and state/local employee benefit plans, though the exact mechanism is not detailed in the text provided. The accompanying analysis notes that the bill includes provisions intended to exempt its requirements from existing ERISA-related restrictions.

Who is affected

  • Health plan issuers that provide health benefit plans with prescription drug coverage in Ohio.
  • Covered individuals who rely on prescription medications to treat qualifying conditions.
  • Plan sponsors and employers offering self-insured or fully insured plans, particularly if ERISA-regulated plans are involved (subject to the ERISA preemption considerations).

Procedural and timeline aspects

  • Effective date: January 1, 2027, for applicability to plans delivered, issued for delivery, modified, or renewed on or after that date.
  • Legislative process: Introduced in February 2026 and referred to committee. (As introduced, not yet enacted into law.)

Practical implications and considerations

  • Potentially broader and more uniform coverage of prescription drugs, reducing reliance on medical necessity determinations that may limit access.
  • Could increase plan costs to health insurers and employers; states often analyze such mandates for fiscal impact, including premium effects and potential savings from improved adherence.
  • Implementation will require plans to verify FDA approval status and recognition in approved compendia or peer-reviewed literature for each drug.
  • The interaction with ERISA-covered plans may require further regulatory guidance or clarification to ensure uniform application across state and federal-regulated plans.

This summary provides a high-level view of HB 699’s substance, affected parties, and timelines. For stakeholders, reviewing the fiscal note and committee analyses will offer estimates of cost implications and detailed regulatory guidance as the bill progresses.

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

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