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To amend sections 127.16 and 2921.13 and to enact | 1 |
sections 5110.01, 5110.02, 5110.03, 5110.05, | 2 |
5110.07 to 5110.19, 5110.21, 5110.22, 5110.23, | 3 |
5110.25, 5110.26, 5110.27, 5110.28, 5110.29, | 4 |
5110.32, 5110.33, 5110.35, 5110.351, 5110.352, | 5 |
5110.353, 5110.354, 5110.36 to 5110.40, 5110.45 to | 6 |
5110.51, 5110.55 to 5110.59, and 5110.99 of the | 7 |
Revised Code to create the Ohio's Best Rx Program | 8 |
and to make an appropriation. | 9 |
Section 1. That sections 127.16 and 2921.13 be amended and | 10 |
sections 5110.01, 5110.02, 5110.03, 5110.05, 5110.07, 5110.08, | 11 |
5110.09, 5110.10, 5110.11, 5110.12, 5110.13, 5110.14, 5110.15, | 12 |
5110.16, 5110.17, 5110.18, 5110.19, 5110.21, 5110.22, 5110.23, | 13 |
5110.25, 5110.26, 5110.27, 5110.28, 5110.29, 5110.32, 5110.33, | 14 |
5110.35, 5110.351, 5110.352, 5110.353, 5110.354, 5110.36, 5110.37, | 15 |
5110.38, 5110.39, 5110.40, 5110.45, 5110.46, 5110.47, 5110.48, | 16 |
5110.49, 5110.50, 5110.51, 5110.55, 5110.56, 5110.57, 5110.58, | 17 |
5110.59, and 5110.99 of the Revised Code be enacted to read as | 18 |
follows: | 19 |
Sec. 127.16. (A) Upon the request of either a state agency | 20 |
or the director of budget and management and after the controlling | 21 |
board determines that an emergency or a sufficient economic reason | 22 |
exists, the controlling board may approve the making of a purchase | 23 |
without competitive selection as provided in division (B) of this | 24 |
section. | 25 |
(B) Except as otherwise provided in this section, no state | 26 |
agency, using money that has been appropriated to it directly, | 27 |
shall: | 28 |
(1) Make any purchase from a particular supplier, that would | 29 |
amount to fifty thousand dollars or more when combined with both | 30 |
the amount of all disbursements to the supplier during the fiscal | 31 |
year for purchases made by the agency and the amount of all | 32 |
outstanding encumbrances for purchases made by the agency from the | 33 |
supplier, unless the purchase is made by competitive selection or | 34 |
with the approval of the controlling board; | 35 |
(2) Lease real estate from a particular supplier, if the | 36 |
lease would amount to seventy-five thousand dollars or more when | 37 |
combined with both the amount of all disbursements to the supplier | 38 |
during the fiscal year for real estate leases made by the agency | 39 |
and the amount of all outstanding encumbrances for real estate | 40 |
leases made by the agency from the supplier, unless the lease is | 41 |
made by competitive selection or with the approval of the | 42 |
controlling board. | 43 |
(C) Any person who authorizes a purchase in violation of | 44 |
division (B) of this section shall be liable to the state for any | 45 |
state funds spent on the purchase, and the attorney general shall | 46 |
collect the amount from the person. | 47 |
(D) Nothing in division (B) of this section shall be | 48 |
construed as: | 49 |
(1) A limitation upon the authority of the director of | 50 |
transportation as granted in sections 5501.17, 5517.02, and | 51 |
5525.14 of the Revised Code; | 52 |
(2) Applying to medicaid provider agreements under Chapter | 53 |
5111. of the Revised Code or payments or provider agreements under | 54 |
the disability medical assistance program established under | 55 |
Chapter 5115. of the Revised Code; | 56 |
(3) Applying to the purchase of examinations from a sole | 57 |
supplier by a state licensing board under Title XLVII of the | 58 |
Revised Code; | 59 |
(4) Applying to entertainment contracts for the Ohio state | 60 |
fair entered into by the Ohio expositions commission, provided | 61 |
that the controlling board has given its approval to the | 62 |
commission to enter into such contracts and has approved a total | 63 |
budget amount for such contracts as agreed upon by commission | 64 |
action, and that the commission causes to be kept itemized records | 65 |
of the amounts of money spent under each contract and annually | 66 |
files those records with the clerk of the house of representatives | 67 |
and the clerk of the senate following the close of the fair; | 68 |
(5) Limiting the authority of the chief of the division of | 69 |
mineral resources management to contract for reclamation work with | 70 |
an operator mining adjacent land as provided in section 1513.27 of | 71 |
the Revised Code; | 72 |
(6) Applying to investment transactions and procedures of any | 73 |
state agency, except that the agency shall file with the board the | 74 |
name of any person with whom the agency contracts to make, broker, | 75 |
service, or otherwise manage its investments, as well as the | 76 |
commission, rate, or schedule of charges of such person with | 77 |
respect to any investment transactions to be undertaken on behalf | 78 |
of the agency. The filing shall be in a form and at such times as | 79 |
the board considers appropriate. | 80 |
(7) Applying to purchases made with money for the per cent | 81 |
for arts program established by section 3379.10 of the Revised | 82 |
Code; | 83 |
(8) Applying to purchases made by the rehabilitation services | 84 |
commission of services, or supplies, that are provided to persons | 85 |
with disabilities, or to purchases made by the commission in | 86 |
connection with the eligibility determinations it makes for | 87 |
applicants of programs administered by the social security | 88 |
administration; | 89 |
(9) Applying to payments by the department of job and family | 90 |
services under section 5111.13 of the Revised Code for group | 91 |
health plan premiums, deductibles, coinsurance, and other | 92 |
cost-sharing expenses; | 93 |
(10) Applying to any agency of the legislative branch of the | 94 |
state government; | 95 |
(11) Applying to agreements or contracts entered into under | 96 |
section 5101.11, 5101.20, 5101.201, 5101.21, or 5101.214 of the | 97 |
Revised Code; | 98 |
(12) Applying to purchases of services by the adult parole | 99 |
authority under section 2967.14 of the Revised Code or by the | 100 |
department of youth services under section 5139.08 of the Revised | 101 |
Code; | 102 |
(13) Applying to dues or fees paid for membership in an | 103 |
organization or association; | 104 |
(14) Applying to purchases of utility services pursuant to | 105 |
section 9.30 of the Revised Code; | 106 |
(15) Applying to purchases made in accordance with rules | 107 |
adopted by the department of administrative services of motor | 108 |
vehicle, aviation, or watercraft fuel, or emergency repairs of | 109 |
such vehicles; | 110 |
(16) Applying to purchases of tickets for passenger air | 111 |
transportation; | 112 |
(17) Applying to purchases necessary to provide public | 113 |
notifications required by law or to provide notifications of job | 114 |
openings; | 115 |
(18) Applying to the judicial branch of state government; | 116 |
(19) Applying to purchases of liquor for resale by the | 117 |
division of liquor control; | 118 |
(20) Applying to purchases of motor courier and freight | 119 |
services made in accordance with department of administrative | 120 |
services rules; | 121 |
(21) Applying to purchases from the United States postal | 122 |
service and purchases of stamps and postal meter replenishment | 123 |
from vendors at rates established by the United States postal | 124 |
service; | 125 |
(22) Applying to purchases of books, periodicals, pamphlets, | 126 |
newspapers, maintenance subscriptions, and other published | 127 |
materials; | 128 |
(23) Applying to purchases from other state agencies, | 129 |
including state-assisted institutions of higher education; | 130 |
(24) Limiting the authority of the director of environmental | 131 |
protection to enter into contracts under division (D) of section | 132 |
3745.14 of the Revised Code to conduct compliance reviews, as | 133 |
defined in division (A) of that section; | 134 |
(25) Applying to purchases from a qualified nonprofit agency | 135 |
pursuant to sections 4115.31 to 4115.35 of the Revised Code; | 136 |
(26) Applying to payments by the department of job and family | 137 |
services to the United States department of health and human | 138 |
services for printing and mailing notices pertaining to the tax | 139 |
refund offset program of the internal revenue service of the | 140 |
United States department of the treasury; | 141 |
(27) Applying to contracts entered into by the department of | 142 |
mental retardation and developmental disabilities under sections | 143 |
5123.18, 5123.182, and 5123.199 of the Revised Code; | 144 |
(28) Applying to payments made by the department of mental | 145 |
health under a physician recruitment program authorized by section | 146 |
5119.101 of the Revised Code; | 147 |
(29) Applying to contracts entered into with persons by the | 148 |
director of commerce for unclaimed funds collection and remittance | 149 |
efforts as provided in division (F) of section 169.03 of the | 150 |
Revised Code. The director shall keep an itemized accounting of | 151 |
unclaimed funds collected by those persons and amounts paid to | 152 |
them for their services. | 153 |
(30) Applying to purchases made by a state institution of | 154 |
higher education in accordance with the terms of a contract | 155 |
between the vendor and an inter-university purchasing group | 156 |
comprised of purchasing officers of state institutions of higher | 157 |
education; | 158 |
(31) Applying to the department of job and family services' | 159 |
purchases of health assistance services under the children's | 160 |
health insurance program part I provided for under section 5101.50 | 161 |
of the Revised Code or the children's health insurance program | 162 |
part II provided for under section 5101.51 of the Revised Code; | 163 |
(32) Applying to payments by the attorney general from the | 164 |
reparations fund to hospitals and other emergency medical | 165 |
facilities for performing medical examinations to collect physical | 166 |
evidence pursuant to section 2907.28 of the Revised Code; | 167 |
(33) Applying to contracts with a contracting authority or | 168 |
administrative receiver under division (G)(2) of section 5126.055 | 169 |
of the Revised Code; | 170 |
(34) Applying to reimbursements paid to the United States | 171 |
department of veterans affairs for pharmaceutical and patient | 172 |
supply purchases made on behalf of the Ohio veterans' home agency; | 173 |
(35) Applying to agreements the department of job and family | 174 |
services enters into with terminal distributors of dangerous drugs | 175 |
under section 5110.12 of the Revised Code. | 176 |
(E) Notwithstanding division (B)(1) of this section, the | 177 |
cumulative purchase threshold shall be seventy-five thousand | 178 |
dollars for the departments of mental retardation and | 179 |
developmental disabilities, mental health, rehabilitation and | 180 |
correction, and youth services. | 181 |
(F) When determining whether a state agency has reached the | 182 |
cumulative purchase thresholds established in divisions (B)(1), | 183 |
(B)(2), and (E) of this section, all of the following purchases by | 184 |
such agency shall not be considered: | 185 |
(1) Purchases made through competitive selection or with | 186 |
controlling board approval; | 187 |
(2) Purchases listed in division (D) of this section; | 188 |
(3) For the purposes of the thresholds of divisions (B)(1) | 189 |
and (E) of this section only, leases of real estate. | 190 |
(G) As used in this section, "competitive selection," | 191 |
"purchase," "supplies," and "services" have the same meanings as | 192 |
in section 125.01 of the Revised Code. | 193 |
Sec. 2921.13. (A) No person shall knowingly make a false | 194 |
statement, or knowingly swear or affirm the truth of a false | 195 |
statement previously made, when any of the following applies: | 196 |
(1) The statement is made in any official proceeding. | 197 |
(2) The statement is made with purpose to incriminate | 198 |
another. | 199 |
(3) The statement is made with purpose to mislead a public | 200 |
official in performing the public official's official function. | 201 |
(4) The statement is made with purpose to secure the payment | 202 |
of unemployment compensation; Ohio works first; prevention, | 203 |
retention, and contingency benefits and services; disability | 204 |
financial assistance; retirement benefits; economic development | 205 |
assistance, as defined in section 9.66 of the Revised Code; or | 206 |
other benefits administered by a governmental agency or paid out | 207 |
of a public treasury. | 208 |
(5) The statement is made with purpose to secure the issuance | 209 |
by a governmental agency of a license, permit, authorization, | 210 |
certificate, registration, release, or provider agreement. | 211 |
(6) The statement is sworn or affirmed before a notary public | 212 |
or another person empowered to administer oaths. | 213 |
(7) The statement is in writing on or in connection with a | 214 |
report or return that is required or authorized by law. | 215 |
(8) The statement is in writing and is made with purpose to | 216 |
induce another to extend credit to or employ the offender, to | 217 |
confer any degree, diploma, certificate of attainment, award of | 218 |
excellence, or honor on the offender, or to extend to or bestow | 219 |
upon the offender any other valuable benefit or distinction, when | 220 |
the person to whom the statement is directed relies upon it to | 221 |
that person's detriment. | 222 |
(9) The statement is made with purpose to commit or | 223 |
facilitate the commission of a theft offense. | 224 |
(10) The statement is knowingly made to a probate court in | 225 |
connection with any action, proceeding, or other matter within its | 226 |
jurisdiction, either orally or in a written document, including, | 227 |
but not limited to, an application, petition, complaint, or other | 228 |
pleading, or an inventory, account, or report. | 229 |
(11) The statement is made on an account, form, record, | 230 |
stamp, label, or other writing that is required by law. | 231 |
(12) The statement is made in connection with the purchase of | 232 |
a firearm, as defined in section 2923.11 of the Revised Code, and | 233 |
in conjunction with the furnishing to the seller of the firearm of | 234 |
a fictitious or altered driver's or commercial driver's license or | 235 |
permit, a fictitious or altered identification card, or any other | 236 |
document that contains false information about the purchaser's | 237 |
identity. | 238 |
(13) The statement is made in a document or instrument of | 239 |
writing that purports to be a judgment, lien, or claim of | 240 |
indebtedness and is filed or recorded with the secretary of state, | 241 |
a county recorder, or the clerk of a court of record. | 242 |
(14) The statement is made with purpose to obtain an Ohio's | 243 |
best Rx program enrollment card under section 5110.09 of the | 244 |
Revised Code or a payment from the department of job and family | 245 |
services under section 5110.17 of the Revised Code. | 246 |
(B) No person, in connection with the purchase of a firearm, | 247 |
as defined in section 2923.11 of the Revised Code, shall knowingly | 248 |
furnish to the seller of the firearm a fictitious or altered | 249 |
driver's or commercial driver's license or permit, a fictitious or | 250 |
altered identification card, or any other document that contains | 251 |
false information about the purchaser's identity. | 252 |
(C) It is no defense to a charge under division (A)(4) of | 253 |
this section that the oath or affirmation was administered or | 254 |
taken in an irregular manner. | 255 |
(D) If contradictory statements relating to the same fact are | 256 |
made by the offender within the period of the statute of | 257 |
limitations for falsification, it is not necessary for the | 258 |
prosecution to prove which statement was false but only that one | 259 |
or the other was false. | 260 |
(E)(1) Whoever violates division (A)(1), (2), (3), (4), (5), | 261 |
(6), (7), (8), (10), (11), | 262 |
guilty of falsification, a misdemeanor of the first degree. | 263 |
(2) Whoever violates division (A)(9) of this section is | 264 |
guilty of falsification in a theft offense. Except as otherwise | 265 |
provided in this division, falsification in a theft offense is a | 266 |
misdemeanor of the first degree. If the value of the property or | 267 |
services stolen is five hundred dollars or more and is less than | 268 |
five thousand dollars, falsification in a theft offense is a | 269 |
felony of the fifth degree. If the value of the property or | 270 |
services stolen is five thousand dollars or more and is less than | 271 |
one hundred thousand dollars, falsification in a theft offense is | 272 |
a felony of the fourth degree. If the value of the property or | 273 |
services stolen is one hundred thousand dollars or more, | 274 |
falsification in a theft offense is a felony of the third degree. | 275 |
(3) Whoever violates division (A)(12) or (B) of this section | 276 |
is guilty of falsification to purchase a firearm, a felony of the | 277 |
fifth degree. | 278 |
(F) A person who violates this section is liable in a civil | 279 |
action to any person harmed by the violation for injury, death, or | 280 |
loss to person or property incurred as a result of the commission | 281 |
of the offense and for reasonable attorney's fees, court costs, | 282 |
and other expenses incurred as a result of prosecuting the civil | 283 |
action commenced under this division. A civil action under this | 284 |
division is not the exclusive remedy of a person who incurs | 285 |
injury, death, or loss to person or property as a result of a | 286 |
violation of this section. | 287 |
Sec. 5110.01. As used in this chapter: | 288 |
(A) "Administrative fee" means the amount specified in rules | 289 |
adopted under division (G) of section 5110.35 of the Revised Code. | 290 |
(B) "Children's health insurance program" means the | 291 |
children's health insurance program part I and part II established | 292 |
under sections 5101.50 to 5101.5110 of the Revised Code. | 293 |
(C) "Disability medical assistance program" means the program | 294 |
established under section 5115.10 of the Revised Code. | 295 |
(D) "Medicaid" means the medical assistance program | 296 |
established under Chapter 5111. of the Revised Code. | 297 |
(E) "National drug code number" means the number registered | 298 |
for a drug pursuant to the listing system established by the | 299 |
United States food and drug administration under the "Drug Listing | 300 |
Act of 1972," 86 Stat. 559, 21 U.S.C. 360, as amended. | 301 |
(F) "Ohio's best Rx program administrator" means the entity, | 302 |
if any, the department of job and family services contracts with | 303 |
pursuant to section 5110.10 of the Revised Code to perform | 304 |
administrative functions of the Ohio's best Rx program and to | 305 |
offer the mail order system through which Ohio's best Rx program | 306 |
participants may obtain drugs by mail. | 307 |
(G) "Ohio's best Rx program applicant" or "applicant" means | 308 |
an individual who signs an application for the Ohio's best Rx | 309 |
program and submits it to the department of job and family | 310 |
services, or the Ohio's best Rx program administrator, for a | 311 |
determination of eligibility for the program. | 312 |
(H) "Ohio's best Rx program participant" or "participant" | 313 |
means an individual determined eligible for the Ohio's best Rx | 314 |
program and included under a valid Ohio's best Rx program | 315 |
enrollment card. | 316 |
(I) "Ohio's best Rx program price" means the price a | 317 |
participating terminal distributor is to charge an Ohio's best Rx | 318 |
program participant for a drug included in the Ohio's best Rx | 319 |
program as determined under section 5110.14 of the Revised Code. | 320 |
"Ohio's best Rx program price" does not include either of the | 321 |
following: | 322 |
(1) The amount of the professional fee, if any, the | 323 |
participating terminal distributor adds to the Ohio's best Rx | 324 |
program price pursuant to an agreement under section 5110.12 of | 325 |
the Revised Code; | 326 |
(2) The amount of the administrative fee, if any, the | 327 |
department of job and family services reports to the participating | 328 |
terminal distributor under section 5110.29 of the Revised Code. | 329 |
(J) "Participating manufacturer" means a drug manufacturer | 330 |
participating in the Ohio's best Rx program pursuant to a rebate | 331 |
agreement. | 332 |
(K) "Participating terminal distributor" means a terminal | 333 |
distributor of dangerous drugs participating in the Ohio's best Rx | 334 |
program pursuant to an agreement entered into with the department | 335 |
of job and family services under section 5110.12 of the Revised | 336 |
Code. | 337 |
(L) "Per unit price," with regard to a state health benefit | 338 |
plan or state retirement system health benefit plan, means the | 339 |
total amount paid to a terminal distributor of dangerous drugs | 340 |
under a state health benefit plan or state retirement system | 341 |
health benefit plan for one unit of a drug covered by the plan, | 342 |
after the plan discounts or otherwise reduces the amount to be | 343 |
paid to the terminal distributor. "Per unit price" includes both | 344 |
of the following: | 345 |
(1) The amount that the state health benefit plan or state | 346 |
retirement system health benefit plan, or other government entity | 347 |
or person authorized to make the payment on behalf of the plan, | 348 |
pays to the terminal distributor of dangerous drugs; | 349 |
(2) The amount that the beneficiary of the state health | 350 |
benefit plan or state retirement system health benefit plan pays | 351 |
to the terminal distributor of dangerous drugs in the form of a | 352 |
copayment, coinsurance, or other cost-sharing charge. | 353 |
(M) "Per unit rebate," with regard to a state health benefit | 354 |
plan or state retirement system health benefit plan, means all | 355 |
rebates, discounts, formulary fees, administrative fees, and other | 356 |
allowances a drug manufacturer pays to the plan, or other | 357 |
government entity or person authorized to receive all or part of | 358 |
such payments, for a drug during a calendar year, divided by the | 359 |
total number of units of that drug dispensed under the plan during | 360 |
the same calendar year. | 361 |
(N) "Rebate administration percentage" means the percentage | 362 |
specified in rules adopted under division (K) of section 5110.35 | 363 |
of the Revised Code. | 364 |
(O) "Rebate agreement" means an agreement under section | 365 |
5110.21 of the Revised Code between the department of job and | 366 |
family services and a drug manufacturer. | 367 |
(P) "State health benefit plan" means a program of health | 368 |
care benefits offered through the Ohio med preferred provider | 369 |
organization, or a successor entity selected by the state, to | 370 |
which either of the following apply: | 371 |
(1) It is provided by a collective bargaining agreement | 372 |
authorized by division (A)(4) of section 4117.03 of the Revised | 373 |
Code. | 374 |
(2) It is offered by the department of administrative | 375 |
services to state employees in accordance with section 124.81 or | 376 |
124.82 of the Revised Code. | 377 |
(Q) "State retirement system" means all of the following: the | 378 |
public employees retirement system, state teachers retirement | 379 |
system, school employees retirement system, Ohio police and fire | 380 |
pension fund, and state highway patrol retirement system. | 381 |
(R) "State retirement system health benefit plan" means a | 382 |
plan of health care benefits offered by a state retirement system | 383 |
under section 145.58, 742.45, 3307.39, 3309.69, or 5505.28 of the | 384 |
Revised Code. | 385 |
(S) "Terminal distributor of dangerous drugs" has the same | 386 |
meaning as in section 4729.01 of the Revised Code. | 387 |
(T) "Third-party payer" has the same meaning as in section | 388 |
3901.38 of the Revised Code. | 389 |
(U) "Trade secret" has the same meaning as in section 1333.61 | 390 |
of the Revised Code. | 391 |
(V) "Usual and customary charge" means the amount a | 392 |
participating terminal distributor or the Ohio's best Rx program | 393 |
administrator charges for a drug included in the program to an | 394 |
individual who does not receive a discounted price for the drug | 395 |
pursuant to any drug discount program, including the Ohio's best | 396 |
Rx program, a prescription drug discount card program established | 397 |
under section 173.061 of the Revised Code, or a pharmacy | 398 |
assistance program established by any person or government entity, | 399 |
and for whom no third-party payer or program funded in whole or | 400 |
part with state or federal funds is responsible for all or part of | 401 |
the cost of the drug the distributor dispenses to the individual. | 402 |
Sec. 5110.02. There is hereby established the Ohio's best Rx | 403 |
program. Except as provided in section 5110.10 of the Revised | 404 |
Code, the department of job and family services shall administer | 405 |
the program. | 406 |
Sec. 5110.03. (A) Except as provided in division (B) of this | 407 |
section, a drug shall be included in the Ohio's best Rx program if | 408 |
the drug is covered by a state health benefit plan or state | 409 |
retirement system health benefit plan or is covered by a rebate | 410 |
agreement entered into under section 5110.21 of the Revised Code. | 411 |
(B) The department of job and family services may exclude | 412 |
from the program a drug covered by a state health benefit plan or | 413 |
state retirement system health benefit plan if the plan receives a | 414 |
rebate for the drug from the manufacturer but the drug is not | 415 |
covered by a rebate agreement entered into under section 5110.21 | 416 |
of the Revised Code. | 417 |
Sec. 5110.05. (A) To be eligible for the Ohio's best Rx | 418 |
program, an individual must meet all of the following requirements | 419 |
at the time of application or reapplication for the program: | 420 |
(1) Be a resident of this state; | 421 |
(2) Have family income, as determined under rules adopted | 422 |
pursuant to section 5110.35 of the Revised Code, that does not | 423 |
exceed two hundred fifty per cent of the federal poverty | 424 |
guidelines, as revised annually by the United States department of | 425 |
health and human services in accordance with section 673(2) of the | 426 |
"Omnibus Budget Reconciliation Act of 1981," 95 Stat. 511, 42 | 427 |
U.S.C. 9902, as amended, or be sixty years of age or older; | 428 |
(3) Not have outpatient prescription drug coverage paid for | 429 |
in whole or in part by any of the following: | 430 |
(a) A third-party payer; | 431 |
(b) The medicaid program; | 432 |
(c) The children's health insurance program; | 433 |
(d) The disability medical assistance program; | 434 |
(e) Another health plan or pharmacy assistance program that | 435 |
uses state or federal funds to pay part or all of the cost of the | 436 |
individual's outpatient prescription drugs, other than a | 437 |
prescription drug discount card program established under section | 438 |
173.061 of the Revised Code. | 439 |
(4) Not have had outpatient prescription drug coverage | 440 |
specified in division (A)(3) of this section during any of the | 441 |
four months preceding the month in which the application or | 442 |
reapplication for the Ohio's best Rx program is made, unless any | 443 |
of the following applies: | 444 |
(a) The individual is sixty years of age or older. | 445 |
(b) The third-party payer that paid all or part of the | 446 |
coverage filed for bankruptcy under federal bankruptcy laws. | 447 |
(c) The individual is no longer eligible for coverage | 448 |
provided through a retirement plan subject to protection under the | 449 |
"Employee Retirement Income Security Act of 1974," 88 Stat. 832, | 450 |
29 U.S.C. 1001, as amended. | 451 |
(d) The individual is no longer eligible for the medicaid | 452 |
program, children's health insurance program, or disability | 453 |
medical assistance program. | 454 |
(B) Application and annual reapplication for the Ohio's best | 455 |
Rx program shall be made in accordance with rules adopted under | 456 |
section 5110.35 of the Revised Code on a form prescribed in those | 457 |
rules. An individual may apply or reapply on behalf of the | 458 |
individual and the individual's spouse and children. The guardian | 459 |
or custodian of an individual may apply or reapply on behalf of | 460 |
the individual. | 461 |
Sec. 5110.07. The department of job and family services | 462 |
shall provide each applicant for the Ohio's best Rx program | 463 |
information about the medicaid program in accordance with rules | 464 |
adopted under section 5110.35 of the Revised Code. The information | 465 |
shall include general eligibility requirements, application | 466 |
procedures, and benefits. The information shall also explain the | 467 |
ways in which the medicaid program's drug benefits are better than | 468 |
the Ohio's best Rx program. | 469 |
Sec. 5110.08. On receipt of applications and annual | 470 |
reapplications, the department of job and family services shall | 471 |
make eligibility determinations for the Ohio's best Rx program in | 472 |
accordance with procedures established in rules adopted under | 473 |
section 5110.35 of the Revised Code. Each determination that an | 474 |
individual is eligible is valid for one year beginning on a date | 475 |
determined in accordance with the eligibility determination | 476 |
procedures. The beginning date may not precede the date on which | 477 |
the individual's eligibility is determined. Annual reapplication | 478 |
may be made under division (B) of section 5110.05 of the Revised | 479 |
Code if the individual seeks to continue to participate in the | 480 |
program after the date eligibility would otherwise end. | 481 |
An eligibility determination under this section may not be | 482 |
appealed under Chapter 119., section 5101.35, or any other | 483 |
provision of the Revised Code. | 484 |
Sec. 5110.09. The department of job and family services | 485 |
shall issue Ohio's best Rx program enrollment cards to or on | 486 |
behalf of individuals determined eligible to participate. One | 487 |
enrollment card may cover each member of a family determined | 488 |
eligible to participate. The card is valid only during the period | 489 |
each individual covered by the card is eligible to participate. | 490 |
The card shall be presented to a participating terminal | 491 |
distributor each time a drug included in the program is purchased | 492 |
under the program. | 493 |
Sec. 5110.10. Subject to section 5110.11 of the Revised Code, | 494 |
the department of job and family services may contract with a | 495 |
person to be the Ohio's best Rx program administrator. | 496 |
The Ohio's best Rx program administrator shall do all of the | 497 |
following: | 498 |
(A) Perform any duty this chapter gives the department that | 499 |
the department specifies in the contract, other than adoption of | 500 |
rules under sections 5110.35 and 5110.36 of the Revised Code and | 501 |
employment of an ombudsperson under section 5110.40 of the Revised | 502 |
Code; | 503 |
(B) Subject to division (P) of section 5110.35 of the Revised | 504 |
Code, offer the mail order system through which Ohio's best Rx | 505 |
program participants may obtain drugs; | 506 |
(C) Charge an Ohio's best Rx program participant for each | 507 |
drug included in the program an amount not exceeding the Ohio's | 508 |
best Rx program price as determined under section 5110.14 of the | 509 |
Revised Code plus the administrative fee described in division (F) | 510 |
of section 5110.12 of the Revised Code, if any. | 511 |
Sec. 5110.11. Before entering into a contract under section | 512 |
5110.10 of the Revised Code with a person to be the Ohio's best Rx | 513 |
program administrator, the department of job and family services | 514 |
shall issue a request for proposals from persons seeking to be | 515 |
considered. The department shall develop a process which it shall | 516 |
use in issuing the request for proposals, receiving responses to | 517 |
the request, and evaluating the responses on a competitive basis. | 518 |
In accordance with that process, the department shall select the | 519 |
person to be awarded the contract. | 520 |
Sec. 5110.12. A terminal distributor of dangerous drugs may | 521 |
enter into an agreement with the department of job and family | 522 |
services to participate in the Ohio's best Rx program for purposes | 523 |
of dispensing drugs. Before entering into an agreement with a | 524 |
terminal distributor, the department shall provide the terminal | 525 |
distributor with a formula that allows the terminal distributor to | 526 |
calculate the price of each drug included in the program, a | 527 |
statistically valid sampling of drug prices that includes the | 528 |
prices of not less than two branded and two generic drugs from | 529 |
each category of drugs included in the program, or the current | 530 |
Ohio's best Rx program price for each drug included in the | 531 |
program. | 532 |
An agreement entered into under this section shall do all of | 533 |
the following: | 534 |
(A) Except as provided in division (C) of this section, be in | 535 |
effect for not less than one year; | 536 |
(B) Specify the dates that the agreement is to begin and end; | 537 |
(C) Permit the participating terminal distributor to | 538 |
terminate the agreement before the date the agreement would | 539 |
otherwise end as specified pursuant to division (B) of this | 540 |
section by providing the department notice of early termination at | 541 |
least thirty days before the effective date of the early | 542 |
termination; | 543 |
(D) Require that the participating terminal distributor | 544 |
charge an Ohio's best Rx program participant for each drug | 545 |
included in the program the lesser of (1) the sum of the Ohio's | 546 |
best Rx program price as determined under section 5110.14 of the | 547 |
Revised Code, the professional fee under division (E) of this | 548 |
section, if any, and the administrative fee under division (F) of | 549 |
this section, if any, or (2) the terminal distributor's usual and | 550 |
customary charge; | 551 |
(E) Permit the participating terminal distributor to add to | 552 |
the Ohio's best Rx program price a professional fee in an amount | 553 |
not to exceed, except as provided in rules adopted under section | 554 |
5110.35 of the Revised Code, three dollars; | 555 |
(F) Require the participating terminal distributor to add to | 556 |
the Ohio's best Rx program price an administrative fee, in an | 557 |
amount determined in accordance with rules adopted under section | 558 |
5110.35 of the Revised Code, for each transaction in which a | 559 |
quantity of the drug is dispensed if an administrative fee is | 560 |
required by those rules; | 561 |
(G) Require the participating terminal distributor to | 562 |
disclose to each participant the amount the participant saves | 563 |
under the program as determined in accordance with section 5110.15 | 564 |
of the Revised Code; | 565 |
(H) Require the participating terminal distributor to submit | 566 |
a claim to the department under section 5110.16 of the Revised | 567 |
Code for each sale of a drug to a participant; | 568 |
(I) Permit the participating terminal distributor to deliver | 569 |
drugs to Ohio's best Rx program participants by mail. | 570 |
Sec. 5110.13. The department of job and family services may | 571 |
not prohibit a terminal distributor of dangerous drugs from | 572 |
participating in any other program the department administers on | 573 |
the basis that the terminal distributor has not entered into an | 574 |
agreement under section 5110.12 of the Revised Code. | 575 |
No entity under contract with the department under section | 576 |
5110.10 of the Revised Code may prohibit a terminal distributor of | 577 |
dangerous drugs from participating in a program or network the | 578 |
entity administers or operates on the basis that the terminal | 579 |
distributor has not entered into an agreement under section | 580 |
5110.12 of the Revised Code. | 581 |
Sec. 5110.14. The Ohio's best Rx program price for a drug | 582 |
included in the program, as described in section 5110.03 of the | 583 |
Revised Code, shall be determined by multiplying the number of | 584 |
units of the drug a participating terminal distributor dispenses | 585 |
to a participant by whichever of the following is applicable: | 586 |
(A) If the drug is not subject to a rebate agreement entered | 587 |
into under section 5110.21 of the Revised Code, the amount | 588 |
computed under division (A)(1) or (2) of section 5110.27 of the | 589 |
Revised Code, as applicable; | 590 |
(B) If the drug is subject to a rebate agreement entered into | 591 |
under section 5110.21 of the Revised Code, the amount computed | 592 |
under division (C) of section 5110.27 of the Revised Code. | 593 |
Sec. 5110.15. The amount that an Ohio's best Rx program | 594 |
participant saves under the program on a transaction for a drug | 595 |
included in the program shall be determined by subtracting the sum | 596 |
of the following from the usual and customary charge for that | 597 |
quantity of the drug the participating terminal distributor or | 598 |
Ohio's best Rx program administrator dispenses to the participant: | 599 |
(A) The Ohio's best Rx program price multiplied by the number | 600 |
of units of the drug dispensed; | 601 |
(B) The professional fee, if any, the distributor or | 602 |
administrator is permitted to charge pursuant to an agreement | 603 |
under section 5110.12 of the Revised Code or a contract under | 604 |
section 5110.10 of the Revised Code; | 605 |
(C) The administrative fee, if any, the department of job and | 606 |
family services reports to the distributor or administrator under | 607 |
section 5110.29 of the Revised Code. | 608 |
Sec. 5110.16. A participating terminal distributor or the | 609 |
Ohio's best Rx program administrator shall submit a claim to the | 610 |
department of job and family services for each drug dispensed to | 611 |
an Ohio's best Rx program participant not later than thirty days | 612 |
after the drug is dispensed. The claim shall be submitted in | 613 |
accordance with the electronic method provided for in rules | 614 |
adopted under section 5110.35 of the Revised Code. | 615 |
The claim shall specify all of the following: | 616 |
(A) The prescription number of the participant's prescription | 617 |
under which the drug is dispensed to the participant; | 618 |
(B) The name of, and national drug code number for, the drug | 619 |
dispensed to the participant; | 620 |
(C) The number of units of the drug dispensed to the | 621 |
participant; | 622 |
(D) The amount the distributor or administrator charged the | 623 |
participant for the drug; | 624 |
(E) The date that the distributor or administrator dispensed | 625 |
the drug to the participant; | 626 |
(F) Any additional information required by rules adopted | 627 |
under section 5110.35 of the Revised Code. | 628 |
Sec. 5110.17. (A) In accordance with rules adopted under | 629 |
section 5110.35 of the Revised Code and subject to section 5110.19 | 630 |
of the Revised Code, the department of job and family services | 631 |
shall pay a participating terminal distributor or the Ohio's best | 632 |
Rx program administrator for complete and timely claims for drugs | 633 |
included in the program that are covered by a rebate agreement | 634 |
entered into under section 5110.21 of the Revised Code. The | 635 |
payment for a complete and timely claim shall be made by a date | 636 |
that is not later than two weeks after the claim is received by | 637 |
the department. | 638 |
(B) Subject to division (D) of this section, the amount to be | 639 |
paid for a claim shall be determined as follows: | 640 |
(1) Multiply the rebate amount for the national drug code | 641 |
number for the drug for which the claim is made, as agreed to | 642 |
under division (B)(4)(a) of section 5110.21 of the Revised Code or | 643 |
computed under division (B) of section 5110.27 of the Revised | 644 |
Code, as applicable, by the number of units of the drug dispensed | 645 |
to the Ohio's best Rx program participant; | 646 |
(2) If an administrative fee was charged, for each | 647 |
transaction in which a quantity of the drug was dispensed, | 648 |
subtract from the amount computed under division (B)(1) of this | 649 |
section the administrative fee amount specified in rules adopted | 650 |
under section 5110.35 of the Revised Code. | 651 |
(C) The department may combine claims from a participating | 652 |
terminal distributor or the administrator to make aggregate | 653 |
payments under this section to the distributor or administrator. | 654 |
(D) If the total of the amounts computed under division (B) | 655 |
of this section for any period for which payments are due is a | 656 |
negative number, the terminal distributor or administrator has | 657 |
been overpaid for claims submitted under section 5110.16 of the | 658 |
Revised Code. When there is an overpayment, the department shall | 659 |
reduce future payments to the terminal distributor or | 660 |
administrator under this section or collect an amount from the | 661 |
terminal distributor or administrator sufficient to reimburse the | 662 |
department for the overpayment. | 663 |
Sec. 5110.18. Neither the department of job and family | 664 |
services nor the Ohio's best Rx program administrator may charge a | 665 |
participating terminal distributor for the submission or | 666 |
processing of a claim under sections 5110.16 and 5110.17 of the | 667 |
Revised Code. | 668 |
Sec. 5110.19. The department of job and family services may | 669 |
not make a payment under section 5110.17 of the Revised Code for a | 670 |
claim submitted under section 5110.16 of the Revised Code if any | 671 |
of the following are the case: | 672 |
(A) The claim is submitted by a terminal distributor of | 673 |
dangerous drugs that is neither a participating terminal | 674 |
distributor nor the Ohio's best Rx program administrator. | 675 |
(B) The claim is for a drug that is not included in the | 676 |
program. | 677 |
(C) The claim is for a drug included in the program but the | 678 |
drug is dispensed to an individual who is not covered by a valid | 679 |
Ohio's best Rx program enrollment card. | 680 |
(D) A person or government entity has paid the participating | 681 |
terminal distributor or the administrator through any other | 682 |
prescription drug coverage program or prescription drug discount | 683 |
program for dispensing the drug, unless the payment is | 684 |
reimbursement for redeeming a coupon or is an amount directly paid | 685 |
by a drug manufacturer to the terminal distributor for dispensing | 686 |
drugs to residents of a long-term care facility. | 687 |
Sec. 5110.21. (A) A drug manufacturer may enter into a | 688 |
rebate agreement with the department of job and family services | 689 |
regarding drugs it manufactures. The agreement shall specify the | 690 |
time it is to be in effect, which shall be not less than one year | 691 |
from the date the agreement is entered into. | 692 |
(B) The agreement shall do all of the following: | 693 |
(1) Specify which of the manufacturer's drugs are included in | 694 |
the agreement; | 695 |
(2) Permit the department to remove a drug from the agreement | 696 |
in the event of a dispute over the drug's utilization; | 697 |
(3) Require that the manufacturer make a rebate payment to | 698 |
the department for each drug specified under division (B)(1) of | 699 |
this section that is dispensed to an Ohio's best Rx program | 700 |
participant; | 701 |
(4)(a) Require that the per unit rebate be in an amount equal | 702 |
to the greater of the following: | 703 |
(i) The weighted average of the per unit rebates for the drug | 704 |
as computed under division (C)(1) of this section; | 705 |
(ii) A per unit amount specified by the manufacturer. | 706 |
(b) Require that the rebate payment for a quantity of a drug | 707 |
dispensed to an Ohio's best Rx participant be equal to the amount | 708 |
determined by multiplying the applicable per unit rebate by the | 709 |
number of units dispensed. | 710 |
(5) Specify the intervals at which the manufacturer will | 711 |
report to the department amounts specified pursuant to division | 712 |
(B)(4)(a)(ii) of this section; | 713 |
(6) Require that the manufacturer make the rebate payments to | 714 |
the department on a quarterly basis or in accordance with a | 715 |
schedule established by rules adopted under section 5110.35 of the | 716 |
Revised Code. | 717 |
(C)(1) For the purposes of division (B)(4)(a)(i) of this | 718 |
section, once each year the department shall compute the weighted | 719 |
average of the per unit rebates for each drug using the | 720 |
information available to the department from submissions under | 721 |
division (A)(4) of section 5110.25 of the Revised Code. The | 722 |
computation shall be made in accordance with section 5110.28 of | 723 |
the Revised Code and rules adopted under section 5110.35 of the | 724 |
Revised Code. | 725 |
(2) If no computation can be made under division (C)(1) of | 726 |
this section, the rebate for the drug shall be the amount | 727 |
specified under (B)(4)(a)(ii) of this section. | 728 |
(D) On submission to the department by a manufacturer that | 729 |
has entered into a rebate agreement under this section of a | 730 |
request the department considers reasonable, the department shall | 731 |
permit the manufacturer to audit claims submitted under section | 732 |
5110.16 of the Revised Code. | 733 |
Sec. 5110.22. If a drug manufacturer has not entered into a | 734 |
rebate agreement under section 5110.21 of the Revised Code with | 735 |
respect to a drug it manufactures that is covered by a state | 736 |
health benefit plan or state retirement system health benefit plan | 737 |
that receives a rebate for the drug from the manufacturer, the | 738 |
department of job and family services shall ask the department of | 739 |
administrative services and each state retirement system to | 740 |
determine whether the drug should be placed, for the following | 741 |
plan year, on a prior authorization list of the state health | 742 |
benefit plan or state retirement system health benefit plan. | 743 |
Additions made under this section to prior authorization | 744 |
lists shall be made in accordance with state law and applicable | 745 |
collectively bargained agreements. | 746 |
Sec. 5110.23. (A) The department of job and family services | 747 |
shall compile both of the following: | 748 |
(1) A list consisting of the name of each drug manufacturer | 749 |
that enters into a rebate agreement under section 5110.21 of the | 750 |
Revised Code and the names of the drugs included in each rebate | 751 |
agreement; | 752 |
(2) A list consisting of the name of each participating | 753 |
terminal distributor. | 754 |
(B) The lists compiled under this section are public records | 755 |
for the purpose of section 149.43 of the Revised Code. The | 756 |
department shall specifically make the lists available to | 757 |
physicians, participating terminal distributors, and other health | 758 |
professionals. | 759 |
Sec. 5110.25. (A) All of the following information shall be | 760 |
submitted to the department of job and family services with | 761 |
respect to a state health benefit plan and each state retirement | 762 |
system health benefit plan: | 763 |
(1) The name of the plan; | 764 |
(2) The number of individuals eligible for benefits under the | 765 |
plan; | 766 |
(3) The formula used to determine the per unit price for each | 767 |
drug covered by the plan and dispensed through means other than a | 768 |
mail order system, the per unit price for those drugs, or, if the | 769 |
formula and per unit price are available for submission under this | 770 |
section, both the formula and per unit price. | 771 |
(4) The per unit rebate for each drug covered by the plan and | 772 |
dispensed through a mail order system or means other than a mail | 773 |
order system. | 774 |
(B) The information specified in division (A) of this section | 775 |
shall be submitted in accordance with section 5110.26 of the | 776 |
Revised Code and rules adopted under section 5110.35 of the | 777 |
Revised Code. In the case of a state health benefit plan, the | 778 |
information shall be submitted by the department of administrative | 779 |
services. In the case of a state retirement system health benefit | 780 |
plan, the information shall be submitted by the state retirement | 781 |
system that offers the health benefit plan. The department of | 782 |
administrative services and each state retirement system shall | 783 |
ensure in all of their relationships with other persons that they | 784 |
are able to submit the information to the department of job and | 785 |
family services. | 786 |
Sec. 5110.26. In submitting information about a drug under | 787 |
section 5110.25 of the Revised Code, the department of | 788 |
administrative services and each state retirement system shall do | 789 |
all of the following: | 790 |
(A) Compute and submit information separately for each of the | 791 |
drug's national drug code numbers; | 792 |
(B) Submit the formula, per unit price, or formula and per | 793 |
unit price information after each change to the formula or per | 794 |
unit price, unless the formula or per unit price changes more than | 795 |
once a week, in which case submit the formula or per unit price | 796 |
information at least once each week; | 797 |
(C) Provide for the formula or per unit price information to | 798 |
reflect the formula or per unit price as most recently changed; | 799 |
(D) Submit the information regarding the per unit rebate once | 800 |
a year and provide for the information to reflect the per unit | 801 |
rebate for the previous calendar year. | 802 |
Sec. 5110.27. In accordance with section 5110.28 of the | 803 |
Revised Code and rules adopted under section 5110.35 of the | 804 |
Revised Code, the department of job and family services shall do | 805 |
all of the following for each drug included in the Ohio's best Rx | 806 |
program: | 807 |
(A) On receipt of each submission of formula or per unit | 808 |
price information under division (A)(3) of section 5110.25 of the | 809 |
Revised Code, or, at the department's discretion, more frequent | 810 |
intervals, the department shall do the following using the | 811 |
information available to the department from those submissions: | 812 |
(1) If the drug is covered by one or more state health | 813 |
benefit plans or state retirement system health benefit plans, | 814 |
compute the weighted average of the per unit prices under those | 815 |
plans; | 816 |
(2) If the drug is not covered by any state health benefit | 817 |
plan or state retirement system health benefit plan, compute a | 818 |
weighted average per unit price using the formula information | 819 |
received under division (A)(3) of section 5110.25 of the Revised | 820 |
Code for comparable drugs covered by one or more state health | 821 |
benefit plans or state retirement system health benefit plans. | 822 |
(B) If the drug is covered by a rebate agreement entered into | 823 |
under section 5110.21 of the Revised Code and the department has | 824 |
established a rebate administration percentage by rule adopted | 825 |
under section 5110.35 of the Revised Code, at intervals specified | 826 |
by the department, the department shall do both of the following: | 827 |
(1) Multiply the amount agreed to under division (B)(4)(a) of | 828 |
section 5110.21 of the Revised Code by the rebate administration | 829 |
percentage; | 830 |
(2) Subtract the product determined under division (B)(1) of | 831 |
this section from the amount agreed to under division (B)(4)(a) of | 832 |
section 5110.21 of the Revised Code. | 833 |
(C) If the drug is covered by a rebate agreement entered into | 834 |
under section 5110.21 of the Revised Code, on receipt of each | 835 |
submission of formula or per unit price information under division | 836 |
(A)(3) of section 5110.25 of the Revised Code, or, at the | 837 |
department's discretion, more frequent intervals, the department | 838 |
shall subtract the amount agreed to under division (B)(4) of | 839 |
section 5110.21 of the Revised Code or the amount computed under | 840 |
division (B) of this section, as applicable, from the applicable | 841 |
amount computed under division (A)(1) or (2) of this section. | 842 |
Sec. 5110.28. The department of job and family services | 843 |
shall use the number of individuals eligible for benefits under a | 844 |
state health benefit plan or state retirement system health | 845 |
benefit plan to compute the weighted averages required by division | 846 |
(C)(1) of section 5110.21 and division (A) of section 5110.27 of | 847 |
the Revised Code. | 848 |
Sec. 5110.29. The department of job and family services | 849 |
shall report all of the following to each participating terminal | 850 |
distributor and the Ohio's best Rx program administrator in a | 851 |
manner enabling the distributor and administrator to comply with | 852 |
section 5110.14 of the Revised Code: | 853 |
(A) For each drug included in the Ohio's best Rx program that | 854 |
is not covered by a rebate agreement under section 5110.21 of the | 855 |
Revised Code, the results of the department's computations under | 856 |
division (A) of section 5110.27 of the Revised Code. | 857 |
(B) For each drug included in the program that is covered by | 858 |
a rebate agreement entered into under section 5110.21 of the | 859 |
Revised Code, the results of the department's computations under | 860 |
division (C) of section 5110.27 of the Revised Code. | 861 |
(C) The administrative fee, if any, determined by the | 862 |
department in accordance with rules adopted under section 5110.35 | 863 |
of the Revised Code. | 864 |
Sec. 5110.32. (A) The Ohio's best Rx program fund is hereby | 865 |
created. The fund shall be in the custody of the treasurer of | 866 |
state, but shall not be part of the state treasury. The fund shall | 867 |
consist of the following: | 868 |
(1) Rebate payments made by participating manufacturers made | 869 |
pursuant to agreements under section 5110.21 of the Revised Code; | 870 |
(2) Administrative fees; | 871 |
(3) The fund's investment earnings. | 872 |
(B) The department of job and family services shall use money | 873 |
in the Ohio's best Rx program fund to make payments to | 874 |
participating terminal distributors and the Ohio's best Rx program | 875 |
administrator under section 5110.17 of the Revised Code. | 876 |
Sec. 5110.33. (A) The Ohio's best Rx administration fund is | 877 |
hereby created in the state treasury. The treasurer of state shall | 878 |
transfer from the Ohio's best Rx program fund to the Ohio's best | 879 |
Rx administration fund amounts equal to the following: | 880 |
(1) Amounts resulting from application of the rebate | 881 |
administration percentage determined under section 5110.354 of the | 882 |
Revised Code; | 883 |
(2) The amount of administrative fees charged Ohio's best Rx | 884 |
participants; | 885 |
(3) The amount of investment earnings credited to the Ohio's | 886 |
best Rx program fund. | 887 |
The treasurer of state shall make the transfers in accordance | 888 |
with a schedule developed by the treasurer of state and the | 889 |
department of job and family services. | 890 |
(B) The department of job and family services shall use money | 891 |
in the Ohio's best Rx administration fund to pay the | 892 |
administrative costs of the Ohio's best Rx program, including, but | 893 |
not limited to, costs associated with contracted services, staff, | 894 |
outreach activities, computers and network services, and the | 895 |
Ohio's best Rx program council. | 896 |
Sec. 5110.35. The department of job and family services | 897 |
shall adopt rules in accordance with Chapter 119. of the Revised | 898 |
Code to implement the Ohio's best Rx program. The rules shall | 899 |
provide for all of the following: | 900 |
(A) Determination of family income for the purpose of | 901 |
division (A)(2) of section 5110.05 of the Revised Code; | 902 |
(B) For the purpose of section 5110.06 of the Revised Code, | 903 |
the application and annual reapplication process for the program | 904 |
and documentation to be submitted with applications and | 905 |
reapplications for the purpose of verifying eligibility; | 906 |
(C) For the purpose of section 5110.06 of the Revised Code | 907 |
and subject to section 5110.351 of the Revised Code, the | 908 |
application form for the program; | 909 |
(D) The method of providing information about the medicaid | 910 |
program to applicants under section 5110.07 of the Revised Code; | 911 |
(E) For the purpose of section 5110.08 of the Revised Code, | 912 |
eligibility determination procedures; | 913 |
(F) Subject to section 5110.352 of the Revised Code, | 914 |
periodically increasing the maximum professional fee that | 915 |
participating terminal distributors may charge Ohio's best Rx | 916 |
program participants under section 5110.12 of the Revised Code or | 917 |
the Ohio's best Rx program administrator may charge under a | 918 |
contract entered into under section 5110.10 of the Revised Code; | 919 |
(G) Subject to section 5110.353 of the Revised Code, the | 920 |
amount of the administrative fee, if any, participating terminal | 921 |
distributors are to charge Ohio's best Rx program participants | 922 |
under section 5110.12 of the Revised Code or the Ohio's best Rx | 923 |
program administrator may charge under a contract entered into | 924 |
under section 5110.10 of the Revised Code; | 925 |
(H) The electronic method for participating terminal | 926 |
distributors and the Ohio's best Rx program administrator to | 927 |
submit claims to the department under section 5110.16 of the | 928 |
Revised Code; | 929 |
(I) Additional information participating terminal | 930 |
distributors and the Ohio's best Rx program administrator shall | 931 |
include on claims submitted under section 5110.16 of the Revised | 932 |
Code that the department determines is necessary for the | 933 |
department to be able to make payments under section 5110.17 of | 934 |
the Revised Code; | 935 |
(J) The method for making payments to participating terminal | 936 |
distributors or the Ohio's best Rx program administrator under | 937 |
section 5110.17 of the Revised Code; | 938 |
(K) Subject to section 5110.354 of the Revised Code, the | 939 |
percentage that is the rebate administration percentage; | 940 |
(L) If the department determines it is best that | 941 |
participating manufacturers make rebates under section 5110.21 of | 942 |
the Revised Code on a basis other than quarterly, a schedule for | 943 |
payment of the rebates; | 944 |
(M) The process for the department of administrative services | 945 |
and state retirement systems to calculate and submit the | 946 |
information required by section 5110.25 of the Revised Code; | 947 |
(N) Procedures for making computations under sections 5110.21 | 948 |
and 5110.27 of the Revised Code; | 949 |
(O) Standards and procedures for the use and preservation of | 950 |
records regarding the Ohio's best Rx program by the department and | 951 |
the Ohio's best Rx program administrator pursuant to section | 952 |
5110.59 of the Revised Code; | 953 |
(P) For the purpose of section 5110.10 of the Revised Code, | 954 |
the standards and procedures governing the operation of the mail | 955 |
order system by the Ohio's best Rx program administrator; | 956 |
(Q) The efficient administration of other provisions of this | 957 |
chapter for which the department determines rules are necessary. | 958 |
Sec. 5110.351. In adopting a rule under division (C) of | 959 |
section 5110.35 of the Revised Code to prescribe the application | 960 |
form for the Ohio's best Rx program, the department of job and | 961 |
family services shall do all of the following: | 962 |
(A) Specify the information that an applicant must include in | 963 |
the application about the applicant and the members of the | 964 |
applicant's family included in the application; | 965 |
(B) Require that the applicant attest that the information | 966 |
the applicant provides in the application and the documentation | 967 |
submitted with the application is accurate to the best knowledge | 968 |
and belief of the applicant; | 969 |
(C) Include a statement printed in bold letters informing the | 970 |
applicant that knowingly making a false statement on the form is | 971 |
falsification under section 2921.13 of the Revised Code, a | 972 |
misdemeanor of the first degree. | 973 |
Sec. 5110.352. As used in this section, "medicaid dispensing | 974 |
fee" means the dispensing fee established under section 5111.08 of | 975 |
the Revised Code for the medicaid program. | 976 |
In adopting a rule under division (F) of section 5110.35 of | 977 |
the Revised Code increasing the maximum amount of the professional | 978 |
fee participating terminal distributors may charge Ohio's best Rx | 979 |
program participants under section 5110.12 of the Revised Code and | 980 |
the Ohio's best Rx program administrator may charge under a | 981 |
contract entered into under section 5110.10 of the Revised Code, | 982 |
the department of job and family services shall review the amount | 983 |
of the professional fee once a year or, at the department's | 984 |
discretion, at more frequent intervals and shall not increase the | 985 |
professional fee to an amount exceeding the medicaid dispensing | 986 |
fee. | 987 |
A participating terminal distributor and the Ohio's best Rx | 988 |
program administrator may charge a maximum three dollar | 989 |
professional fee regardless of whether the medicaid dispensing fee | 990 |
for that drug is less than that amount. The department, however, | 991 |
may not adopt a rule increasing the maximum professional fee for | 992 |
that drug until the medicaid dispensing fee for that drug exceeds | 993 |
that amount. | 994 |
Sec. 5110.353. (A) Once a year or, at the discretion of the | 995 |
department of job and family services, at more frequent intervals, | 996 |
the department shall determine the amount, if any, to be specified | 997 |
in a rule adopted under division (G) of section 5110.35 of the | 998 |
Revised Code as the administrative fee. In determining the amount | 999 |
of the administrative fee, the department shall determine an | 1000 |
amount, not exceeding one dollar per transaction, that equals or | 1001 |
is less than the amount needed to cover the administrative costs | 1002 |
of the Ohio's best Rx program when added to the sum of the | 1003 |
following: | 1004 |
(1) The amount resulting from the application of the rebate | 1005 |
administration percentage; | 1006 |
(2) The investment earnings of the Ohio's best Rx program | 1007 |
fund created by section 5110.32 of the Revised Code. | 1008 |
(B) Once a year or, at the discretion of the department, at | 1009 |
more frequent intervals, the department shall report the | 1010 |
methodology underlying the determination of the administrative fee | 1011 |
to the Ohio's best Rx program council. | 1012 |
Sec. 5110.354. (A) At least once a year or, at the discretion | 1013 |
of the department of job and family services, at more frequent | 1014 |
intervals, the department shall determine the percentage, if any, | 1015 |
to be specified in a rule adopted under division (K) of section | 1016 |
5110.35 of the Revised Code as the rebate administration | 1017 |
percentage. The percentage, which shall not exceed five per cent, | 1018 |
shall result in an amount that equals or is less than the amount | 1019 |
needed to cover the administrative costs of the Ohio's best Rx | 1020 |
program when added to the sum of the following: | 1021 |
(1) The administrative fee specified in section 5110.353 of | 1022 |
the Revised Code; | 1023 |
(2) The investment earnings of the Ohio's best Rx program | 1024 |
fund created by section 5110.32 of the Revised Code. | 1025 |
(B) Once a year or, at the discretion of the department, at | 1026 |
more frequent intervals, the department shall report the | 1027 |
methodology underlying the determination of the rebate | 1028 |
administration percentage to the Ohio's best Rx program council. | 1029 |
Sec. 5110.36. Notwithstanding any provision of this chapter, | 1030 |
the department of job and family services may adopt rules in | 1031 |
accordance with Chapter 119. of the Revised Code to make | 1032 |
adjustments to the Ohio's best Rx program that the department | 1033 |
considers appropriate to conform the program to, or coordinate it | 1034 |
with, any federally funded prescription drug program created after | 1035 |
October 1, 2003. | 1036 |
Sec. 5110.37. The department of job and family services | 1037 |
shall undertake outreach efforts to publicize the Ohio's best Rx | 1038 |
program and maximize participation in the program. | 1039 |
Sec. 5110.38. The department of job and family services may | 1040 |
coordinate the Ohio's best Rx program with a state health benefit | 1041 |
plan to enhance efficiency, reduce the cost of drugs, and maximize | 1042 |
the benefits of the Ohio's best Rx program and state health | 1043 |
benefit plans. | 1044 |
Sec. 5110.39. Not later than April 1, 2005, the department | 1045 |
of job and family services shall do all of the following: | 1046 |
(A) Create a list of the twenty-five drugs most often | 1047 |
dispensed to Ohio's best Rx program participants under the | 1048 |
program, using data from the most recent six-month period for | 1049 |
which the data is available; | 1050 |
(B) Determine the average amount that participating terminal | 1051 |
distributors charge, on a date selected by the department, | 1052 |
participants for each drug included on the list created under | 1053 |
division (A) of this section; | 1054 |
(C) Determine, for the date selected for division (B) of this | 1055 |
section, the average usual and customary charge of participating | 1056 |
terminal distributors for each drug included on the list created | 1057 |
under division (A) of this section; | 1058 |
(D) By comparing the average charges determined under | 1059 |
divisions (B) and (C) of this section, determine the average | 1060 |
percentage savings in the amount participating terminal | 1061 |
distributors charge Ohio's best Rx program participants for each | 1062 |
drug included on the list created under division (A) of this | 1063 |
section. | 1064 |
Sec. 5110.40. The department of job and family services shall | 1065 |
employ an ombudsperson to assist terminal distributors of | 1066 |
dangerous drugs with grievances regarding the Ohio's best Rx | 1067 |
program. | 1068 |
Sec. 5110.45. There is hereby created the Ohio's best Rx | 1069 |
program council. The council shall advise the department of job | 1070 |
and family services on the Ohio's best Rx program. With the | 1071 |
approval of a majority of the council's appointed members, the | 1072 |
council may initiate studies to determine whether there are more | 1073 |
effective ways to administer the program and provide the | 1074 |
department with suggestions for improvements. | 1075 |
Sec. 5110.46. The Ohio's best Rx program council shall | 1076 |
consist of the following members: | 1077 |
(A) The president of the senate; | 1078 |
(B) The speaker of the house of representatives; | 1079 |
(C) The minority leader of the senate; | 1080 |
(D) The minority leader of the house of representatives; | 1081 |
(E) A representative of the Ohio chapter of the American | 1082 |
federation of labor-congress of industrial organizations, | 1083 |
appointed by the governor from a list of names submitted to the | 1084 |
governor by that organization; | 1085 |
(F) A representative of the Ohio chapter of the American | 1086 |
association of retired persons, appointed by the governor from a | 1087 |
list of names submitted to the governor by that organization; | 1088 |
(G) A representative of a disability advocacy organization | 1089 |
located in the state of Ohio, appointed by the governor from a | 1090 |
list of names submitted to the governor by disability advocacy | 1091 |
organizations located in the state of Ohio; | 1092 |
(H) A representative of the Ohio chapter of the united way, | 1093 |
appointed by the governor from a list of names submitted to the | 1094 |
governor by that organization; | 1095 |
(I) A representative of the Ohio alliance of retired | 1096 |
Americans, appointed by the governor from a list of names | 1097 |
submitted to the governor by that organization; | 1098 |
(J) Three representatives of research-based drug | 1099 |
manufacturers, appointed by the governor from a list of names | 1100 |
submitted to the governor by the pharmaceutical research and | 1101 |
manufacturers of America; | 1102 |
(K) A pharmacist licensed under Chapter 4729. of the Revised | 1103 |
Code, appointed by the governor from a list of names submitted to | 1104 |
the governor by the Ohio pharmacists association. | 1105 |
Sec. 5110.47. The governor shall make initial appointments | 1106 |
to the Ohio's best Rx program council not later than thirty days | 1107 |
after the effective date of this section. The members appointed by | 1108 |
the governor shall serve at the pleasure of the governor. If an | 1109 |
appointed member's seat becomes vacant, the governor shall fill | 1110 |
the vacancy not later than thirty days after the vacancy occurs | 1111 |
and in the manner provided for the initial appointment. | 1112 |
Sec. 5110.48. The president of the senate and speaker of the | 1113 |
house of representatives shall serve as co-chairs of the Ohio's | 1114 |
best Rx program council. | 1115 |
The president of the senate, the minority leader of the | 1116 |
senate, the speaker of the house of representatives, and the | 1117 |
minority leader of the house of representatives may each appoint a | 1118 |
member of the general assembly to attend any meeting of the Ohio's | 1119 |
best Rx program council on behalf of the president of the senate, | 1120 |
the minority leader of the senate, the speaker of the house of | 1121 |
representatives, or the minority leader of the house of | 1122 |
representatives, respectively. | 1123 |
Sec. 5110.49. Members of the Ohio's best Rx program council | 1124 |
shall serve without compensation and shall not be reimbursed for | 1125 |
any expenses associated with their duties on the council. | 1126 |
Sec. 5110.50. Except for any part of records that contain a | 1127 |
trade secret, the Ohio's best Rx program council's records are a | 1128 |
public record for the purpose of section 149.43 of the Revised | 1129 |
Code. | 1130 |
Sec. 5110.51. Sections 101.82 to 101.87 of the Revised Code | 1131 |
do not apply to the Ohio's best Rx program council. | 1132 |
Sec. 5110.55. Information transmitted by or to any of the | 1133 |
following for any purpose related to the Ohio's best Rx program is | 1134 |
confidential to the extent required by federal and state law: | 1135 |
(A) Drug manufacturers; | 1136 |
(B) Terminal distributors of dangerous drugs; | 1137 |
(C) The Ohio's best Rx program administrator; | 1138 |
(D) The department of job and family services; | 1139 |
(E) The department of administrative services; | 1140 |
(F) The state retirement systems; | 1141 |
(G) A state health benefit plan or state retirement system | 1142 |
health benefit plan; | 1143 |
(H) Ohio's best Rx program participants; | 1144 |
(I) Any other government entity or person. | 1145 |
Sec. 5110.56. (A) Except as provided by section 5110.57 of | 1146 |
the Revised Code, all of the following are trade secrets, are not | 1147 |
public records for the purposes of section 149.43 of the Revised | 1148 |
Code, and shall not be used, released, published, or disclosed in | 1149 |
a form that reveals a specific drug or the identity of a drug | 1150 |
manufacturer: | 1151 |
(1) The amounts determined under section 5110.17 of the | 1152 |
Revised Code; | 1153 |
(2) Information disclosed in a rebate agreement or in | 1154 |
communications related to a rebate agreement; | 1155 |
(3) Information that the department of administrative | 1156 |
services and state retirement systems submit to the department of | 1157 |
job and family services under divisions (A)(3) and (4) of section | 1158 |
5110.25 of the Revised Code; | 1159 |
(4) The elements of the computations under division (C) of | 1160 |
section 5110.21 of the Revised Code and under section 5110.27 of | 1161 |
the Revised Code and any results of those computations that reveal | 1162 |
or could be used to reveal the drug pricing or rebate information | 1163 |
and amounts used to make the computations. | 1164 |
(B) No person or government entity shall use or reveal any | 1165 |
information specified in division (A) of this section except as | 1166 |
required for the implementation of this chapter. | 1167 |
Sec. 5110.57. Sections 5110.55 and 5110.56 of the Revised | 1168 |
Code shall not preclude the department of job and family services | 1169 |
from disclosing information necessary for the implementation of | 1170 |
this chapter, including the Ohio's best Rx program price to | 1171 |
participating terminal distributors or the Ohio's best Rx program | 1172 |
administrator under section 5110.29 of the Revised Code. | 1173 |
Sec. 5110.58. (A) As used in this section, "identifying | 1174 |
information" means information that identifies or could be used to | 1175 |
identify an Ohio's best Rx program applicant or participant. | 1176 |
"Identifying information" does not include aggregate information | 1177 |
about applicants and participants that does not identify and could | 1178 |
not be used to identify an individual applicant or participant. | 1179 |
(B) Except as provided in divisions (C), (D), and (E) of this | 1180 |
section, no person or government entity shall sell, solicit, | 1181 |
disclose, receive, or use identifying information or knowingly | 1182 |
permit the use of identifying information. | 1183 |
(C)(1) The department of job and family services and the | 1184 |
Ohio's best Rx program administrator may solicit, disclose, | 1185 |
receive, or use identifying information or knowingly permit the | 1186 |
use of identifying information for a purpose directly connected to | 1187 |
the administration of the Ohio's best Rx program, including | 1188 |
disclosing and knowingly permitting the use of identifying | 1189 |
information included in a claim that a participating manufacturer | 1190 |
audits pursuant to division (D) of section 5110.21 of the Revised | 1191 |
Code, contacting Ohio's best Rx program applicants or participants | 1192 |
regarding participation in the program, and notifying applicants | 1193 |
and participants regarding participating terminal distributors. | 1194 |
(2) The department and administrator may solicit, disclose, | 1195 |
receive, or use identifying information or knowingly permit the | 1196 |
use of identifying information to the extent required by federal | 1197 |
law. | 1198 |
(3) The department and administrator may disclose identifying | 1199 |
information to the Ohio's best Rx program applicant or participant | 1200 |
who is the subject of that information or to the parent, spouse, | 1201 |
guardian, or custodian of that applicant or participant. | 1202 |
(D) A participating terminal distributor or the Ohio's best | 1203 |
Rx program administrator may solicit, disclose, receive, or use | 1204 |
identifying information or knowingly permit the use of identifying | 1205 |
information to the extent required or permitted by an agreement | 1206 |
the distributor enters into under section 5110.12 of the Revised | 1207 |
Code or a contract the administrator enters into under section | 1208 |
5110.10 of the Revised Code. | 1209 |
(E) A participating manufacturer may, for the purpose of | 1210 |
auditing a claim pursuant to division (D) of section 5110.21 of | 1211 |
the Revised Code, solicit, receive, and use identifying | 1212 |
information included in the claim. | 1213 |
Sec. 5110.59. The department of job and family services and | 1214 |
the Ohio's best Rx program administrator shall use and preserve | 1215 |
records regarding the Ohio's best Rx program in accordance with | 1216 |
rules adopted under section 5110.35 of the Revised Code. This | 1217 |
section applies to the department's or administrator's use and | 1218 |
preservation of records received or generated by the department, | 1219 |
any other government entity, or any person. | 1220 |
Sec. 5110.99. Whoever violates division (B) of section | 1221 |
5110.58 of the Revised Code is guilty of a misdemeanor of the | 1222 |
first degree. | 1223 |
Section 2. That existing sections 127.16 and 2921.13 of the | 1224 |
Revised Code are hereby repealed. | 1225 |
Section 3. It is not the intention of the General Assembly to | 1226 |
establish an entitlement program through the enactment of Chapter | 1227 |
5110. of the Revised Code by this act. | 1228 |
Section 4. All items in this section are hereby appropriated | 1229 |
as designated out of any moneys in the state treasury to the | 1230 |
credit of the General Revenue Fund and the State Special Revenue | 1231 |
Fund Group. For all appropriations made in this act, those in the | 1232 |
first column are for fiscal year 2004 and those in the second | 1233 |
column are for fiscal year 2005. The appropriations made in this | 1234 |
act are in addition to any other appropriations made for the | 1235 |
2003-2005 biennium. | 1236 |
1237 |
General Revenue Fund | 1238 |
GRF | 600-440 | Ohio's Best Rx Start-Up Costs | $ | 10,000,000 | $ | 0 | 1239 | ||||
TOTAL GRF General Revenue Fund | $ | 10,000,000 | $ | 0 | 1240 |
State Special Revenue Fund Group | 1241 |
5AA | 600-440 | Ohio's Best Rx Administration | $ | 5,000,000 | $ | 5,000,000 | 1242 | ||||
TOTAL SSR State Special Revenue Fund Group | $ | 5,000,000 | $ | 5,000,000 | 1243 | ||||||
TOTAL ALL BUDGET FUND GROUPS | $ | 15,000,000 | $ | 5,000,000 | 1244 |
OHIO'S BEST RX START-UP COSTS | 1245 |
The foregoing appropriation item 600-440, Ohio's Best Rx | 1246 |
Start-Up Costs, shall be used by the Department of Job and Family | 1247 |
Services to pay for the administrative and operational expenses | 1248 |
for the creation and operation of the Ohio's Best Rx Program in | 1249 |
accordance with Chapter 5110. of the Revised Code including costs | 1250 |
associated with the duties assigned by the department to the | 1251 |
Ohio's Best Rx Program Administrator and making payments to | 1252 |
participating terminal distributors until sufficient cash exists | 1253 |
to make payments from the accounts created in sections 5110.32 and | 1254 |
5110.33 of the Revised Code. Of the foregoing appropriation item | 1255 |
600-440, Ohio's Best Rx Start-up Costs, not more than $450,000 in | 1256 |
fiscal year 2004 and not more than $750,000 in fiscal year 2005 | 1257 |
may be used by the department for administrative and operational | 1258 |
costs, excluding outreach, that are not associated with the Ohio's | 1259 |
Best Rx Program Administrator or the payments to participating | 1260 |
terminal distributors. | 1261 |
If the Director of the Department of Job and Family Services | 1262 |
estimates that the appropriation is insufficient to fully cover | 1263 |
start-up costs, the Director shall, in consultation with the | 1264 |
Director of the Office of Budget and Management, submit a letter | 1265 |
to the Governor, President of the Senate, Speaker of the House of | 1266 |
Representatives, and the Minority Leaders of the Senate and House | 1267 |
of Representatives. The letter shall declare the additional | 1268 |
appropriation authority estimated to be needed and shall show a | 1269 |
breakdown of how the additional appropriation authority will be | 1270 |
used. The Director of Job and Family Services shall obtain the | 1271 |
approval of the Controlling Board for any supplemental | 1272 |
appropriation, if required. The amount approved by the Controlling | 1273 |
Board is hereby appropriated. The use of state funds for start-up | 1274 |
costs shall in no way obligate the state to fund further program | 1275 |
costs, as the program is a discount program, not an entitlement | 1276 |
program. Any unspent appropriations from fiscal year 2004 may be | 1277 |
carried over to fiscal year 2005. | 1278 |
OHIO'S BEST RX ADMINISTRATION | 1279 |
The foregoing appropriation item 600-673, Ohio's Best Rx | 1280 |
Administration, shall be used on an ongoing basis to cover | 1281 |
expenses associated with the Ohio's Best Rx Program defined in | 1282 |
section 5110.33 of the Revised Code. If receipts to the fund | 1283 |
exceed the appropriated amounts, the Director of Job and Family | 1284 |
Services may request that the Director of Budget and Management | 1285 |
increase the appropriation authority of this fund. Upon approval | 1286 |
from the Director of Budget and Management, the additional amounts | 1287 |
are hereby appropriated. | 1288 |
Within the limits set forth in this act, the Director of | 1289 |
Budget and Management shall establish accounts indicating source | 1290 |
and amount of funds for each appropriation made in this act, and | 1291 |
shall determine the form and manner in which appropriation | 1292 |
accounts shall be maintained. Expenditures from appropriations | 1293 |
contained in this act shall be accounted for as though made in Am. | 1294 |
Sub. H.B. 95 of the 125th General Assembly. | 1295 |
The appropriations made in this act are subject to all | 1296 |
provisions of Am. Sub. H.B. 95 of the 125th General Assembly that | 1297 |
are generally applicable to such appropriations. | 1298 |
Section 5. The codified and uncodified sections of law | 1299 |
contained in this act, and the items of law of which they are | 1300 |
composed, are not subject to the referendum. Therefore, under Ohio | 1301 |
Constitution, Article II, Section 1d and section 1.471 of the | 1302 |
Revised Code, the codified and uncodified sections of law | 1303 |
contained in this act, and the items of law of which they are | 1304 |
composed, go into immediate effect when this act becomes law. | 1305 |