Section 3901.813 | Proceedings After Audit.
Effective: March 23, 2015 Latest Legislation: Senate Bill 258 – 130th General Assembly (A) Except as provided in division (B) of this section, all of the following apply after a pharmacy audit is completed: (1) A pharmacy shall be given not less than thirty days from the date of the on-site audit to provide the […]
Section 3901.814 | Appeal Process.
Effective: March 23, 2015 Latest Legislation: Senate Bill 258 – 130th General Assembly Each auditing entity in this state shall establish in writing separate procedures for a pharmacy to appeal one or more findings in a preliminary audit report issued under section 3901.813 of the Revised Code.
Section 3901.815 | Applicability of Provisions.
Effective: March 23, 2015 Latest Legislation: Senate Bill 258 – 130th General Assembly Sections 3901.811 to 3901.814 of the Revised Code shall not apply to an auditing entity that is a medicaid managed care organization if application of those sections to the entity would be in violation of federal law.
Section 3901.82 | Restatement of the Law, Liability Insurance.
Effective: October 29, 2018 Latest Legislation: Senate Bill 239 – 132nd General Assembly The “Restatement of the Law, Liability Insurance” that was approved at the 2018 annual meeting of the American law institute does not constitute the public policy of this state and is not an appropriate subject of notice.
Section 3901.83 | Definitions for Sections 3901.83 to 3901.833.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly As used in sections 3901.83 to 3901.833 of the Revised Code: (A) “Clinical practice guidelines” means a systematically developed statement to assist health care provider and patient decisions with regard to appropriate health care for specific clinical circumstances and conditions. (B) “Clinical […]
Section 3901.831 | Implementation of Step Therapy Protocol.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly (A) If a health plan issuer or a utilization review organization implements a step therapy protocol, that protocol shall be implemented via clinical review criteria that are based on clinical practice guidelines or medical or scientific evidence. (B) When establishing a step […]
Section 3901.832 | Step Therapy Exemption.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly (A)(1)(a) When coverage of a prescription drug for the treatment of any medical condition is restricted for use by a health plan issuer or utilization review organization through the use of a step therapy protocol, the health plan issuer or utilization review […]
Section 3901.833 | Adoption of Rules.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly The superintendent of insurance may adopt rules as necessary to enforce sections 3901.83 to 3901.833 of the Revised Code.
Section 3901.81 | Definitions.
Effective: March 23, 2015 Latest Legislation: Senate Bill 258 – 130th General Assembly As used in this section and sections 3901.811 to 3901.815 of the Revised Code: (A) “Auditing entity” means any person or government entity that performs a pharmacy audit, including a payer, a pharmacy benefit manager, or a third-party administrator licensed under Chapter […]
Section 3901.71 | Application of Mandated Health Benefits.
Effective: November 24, 1995 Latest Legislation: Senate Bill 150 – 121st General Assembly (A) As used in this section, “mandated health benefits” means any required coverage, or required offering of coverage, for the expenses of specified services, treatments, or diseases under any policy, contract, plan, or other arrangement providing sickness and accident or other health […]