- with readers working within the Business & Consumer Services industries
On March 31, 2026, Ohio Governor Mike DeWine signed Ohio House Bill 229 into law, marking a significant milestone in pharmacy benefit manager (PBM) reform in the state. These comprehensive reforms establish rigorous licensing, transparency and operational standards for all PBMs operating in Ohio, promising substantial benefits for health plans, employers, insurers, pharmacies and consumers alike.
Effective July 1, 2027, any entity acting as a PBM in Ohio will be required to obtain a license from the Ohio Department of Insurance. This new regulatory framework applies to all PBMs serving Ohio-based health plans, insurers, and employer groups.
Key Provisions of the Law:
- Mandatory PBM Licensing: All PBMs must apply for and obtain a license from the Ohio Department of Insurance, with annual renewal requirements and clear eligibility standards for both individuals and business entities.
- Enhanced Transparency: PBMs are now required to disclose their pricing methodologies, including maximum allowable cost (MAC) lists, and provide plan sponsors with detailed data on rebates and compensation structures.
- Fair Pharmacy Practices: Pharmacies gain new rights to appeal MAC pricing, access up-to-date pricing data and receive reimbursement adjustments.
- Consumer Protections: Patients are protected from excessive cost-sharing, ensuring they are not charged more than the lower of the cash price or the plan’s net reimbursement. Additionally, pharmacies are permitted to mail or deliver prescriptions directly to patients as part of ancillary services.
- Strict Recordkeeping: PBMs must maintain comprehensive transaction records, which are subject to inspection by the Department of Insurance. They are also required to submit annual financial reports to plan sponsors.
- Enforcement and Penalties: The law grants the Superintendent of Insurance broad authority to investigate violations, suspend or revoke licenses, and impose fines of up to $15,000 per violation, ensuring accountability and compliance.
This legislation marks a pivotal step toward greater transparency, fairness and consumer protection in Ohio’s pharmacy benefit landscape. Stakeholders across the healthcare continuum should prepare for upcoming changes that aim to foster a more equitable and accountable PBM industry. By implementing these reforms, Ohio is setting a new standard for pharmacy benefit management in the state that prioritizes patient interests and industry integrity.
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