Legislators have now departed for their summer recess. As a reminder, all legislation introduced this general assembly that does not pass before the end of 2026 would have to be reintroduced and start over with the new general assembly that will convene in 2027. “Lame duck,” the legislative session that will occur this fall when legislators return after the elections, will be a flurry of activity as many elected officials and interested parties race to the finish line, hoping to secure victory with their legislative priorities before the clock runs out.

Thankfully, with the progress made on these two additional insurance reform proposals this week, both SB 160 and HB 220 are in an ideal position heading into the lame duck session, and OSMA will be prepared to advocate in hopes of both making it through the full legislative process this fall.

SB 160 Passes in the Ohio Senate

Wednesday evening, the Ohio Senate passed Senate Bill 160 in a unanimous vote of 33-0. This a major step toward victory for this legislation!

SB 160, as you might recall, addresses non-medical switching, which occurs the insurer requires a patient to switch from their current medication to a different medication for reasons unrelated to the patients’ health. This legislation will place restrictions on removing a medication from a prescription drug formulary during a plan year, and prohibit private health plans from increasing patient cost-sharing or from moving drugs to a more restrictive tier during a plan year.

OSMA strongly believes that treatment decisions should come from the doctor-patient relationship, and that patients, particularly those with chronic and complex medical conditions, need and deserve individualized, patient-centered treatment plans. SB 160 would allow patients to remain stable on their currently-prescribed treatment.

This issue has been on OSMA’s advocacy agenda for years, and we have worked closely with the Ohio Association of Rheumatology (OAR) in our advocacy efforts on SB 160. By passing in the Senate, this legislation is now perfectly positioned for lame duck session. OSMA is optimistic about this step forward and looks forward to continued advocacy on the bill this fall.  

 Prior Authorization Legislation Has First Hearing in Ohio House

This March, we reported that House Bill 220 passed through the Ohio House. This OSMA-supported legislation, which aims to streamline the prior authorization process, has now started the committee hearing process in the Senate, with its first hearing in the Senate Financial Institutions, Insurance, and Technology Committee taking place this week.

As a reminder, HB 220 would:

• Ensure that retroactive denials can only occur in the event of non-covered benefits or lack of coverage at the time of service.

• Hold insurers accountable in the peer-to-peer review process by requiring that prior authorization appeals be between a healthcare provider and a clinical peer, and that the clinical peer (plan clinician) making adverse determinations provide identifying information including their specialty and relevant qualifications.

• Prohibit insurers from charging a fee for appealing an adverse prior authorization determination.

• Require insurers to honor an existing 12-month drug prior authorization approval for a maintenance medication to treat a chronic condition if the provider prescribes a change in dosage of the approved drug.

HB 220 receiving its first hearing in the Senate before the summer recess puts this legislation one step closer to becoming another victory for Ohio physicians and patients!

The bill seemed to be well-received in its first hearing, and OSMA is hopeful that HB 220 has a strong chance of passage during the lame duck session. We will advocate for more hearings on the bill when legislators return after the elections.

Stay tuned for more updates as OSMA continues our advocacy efforts!