S. B. No. 43 As Introduced

Senators Spada, Robert Gardner, Blessing, Coughlin, Schuring, Jacobson, Fingerhut, DiDonato, Wachtmann, Harris, Schuler, Dann

A BILL

To enact sections 1751.111 and 3923.601 of the 1
Revised Code to require health care plans 2
providing prescription drug benefits to use a 3
standardized identification card or other 4
standardized technology in the processing of 5
claims. 6

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

       Section 1. That sections 1751.111 and 3923.601 of the Revised 7
Code be enacted to read as follows: 8

       Sec. 1751.111. (A)(1) This section applies to every health 9
insuring corporation, and to every person contracted by the health 10
insuring corporation to provide managerial or administrative 11
services, that issues or requires the use of a standardized 12
identification card or other standardized technology for the 13
processing of prescription drug and device claims pursuant to a 14
policy, contract, or agreement for health care services. 15

       (2) Notwithstanding division (A)(1) of this section, this 16
section does not apply to the issuance or use of standardized 17
identification cards or other standardized technology for the 18
processing of prescription drug and device claims in connection 19
with coverage provided to beneficiaries enrolled in Title XIX of 20
the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, 21
as amended, known as the medical assistance program or medicaid, 22
by the department of job and family services under Chapter 5111. 23
of the Revised Code. 24

        (B) A standardized identification card or other standardized 25
technology issued or used by a health insuring corporation, or a 26
person providing managerial or administrative services for the 27
health insuring corporation, as provided in division (A) of this 28
section shall contain uniform prescription drug information that 29
meets the requirements of either division (B)(1) or (2) of this 30
section. 31

        (1) The standardized identification card or other 32
standardized technology shall be in a format and contain 33
information fields approved by the national council for 34
prescription drug programs as contained in the council pharmacy 35
identification card implementation guide in effect on the first 36
day of October most immediately preceding the issuance of the 37
standardized identification card. 38

        (2) The standardized identification card or other 39
standardized technology shall contain any of the following 40
information if required for the processing of a claim: 41

        (a) The health insuring corporation's name; 42

        (b) The enrollee's name, group number, and identification 43
number; 44

        (c) A telephone number to inquire about pharmacy-related 45
issues; 46

        (d) The issuer's international identification number or "ANSI 47
BIN" number, labeled as "ANSI BIN" or "RxBIN"; 48

       (e) The processor's control number, labeled as "RxPCN"; 49

        (f) The enrollee's pharmacy benefits group number if 50
different than the enrollee's medical group number, labeled as 51
"RxGrp." 52

        (C) If a standardized identification card or other 53
standardized technology issued under division (B)(2) of this 54
section is also used to process nonpharmacy claims, the use of the 55
designation "Rx" is not required in connection with the labels 56
identified in divisions (B)(2)(d) to (f) of this section. 57

        (D) Health insuring corporations, and persons providing 58
managerial or administrative services for health insuring 59
corporations, shall not be required to issue a standardized 60
identification card or other standardized technology with uniform 61
prescription drug information to an enrollee more than once during 62
a twelve-month period. 63

        (E) Nothing in this section shall be construed as requiring a 64
health insuring corporation to produce more than one standardized 65
identification card or other standardized technology for use by 66
enrollees accessing health care benefits provided under a policy, 67
contract, or agreement for health care services. 68

       Sec. 3923.601. (A)(1) This section applies to every sickness 69
and accident insurer, and to every person contracted by the 70
insurer to provide managerial or administrative services, that 71
issues or requires the use of a standardized identification card 72
or other standardized technology for the processing of 73
prescription drug and device claims pursuant to a policy of 74
sickness and accident insurance. This section also applies to 75
every pharmacy benefit manager, and to every health benefit plan 76
administered by the state, that issues or requires the use of a 77
standardized identification card or other standardized technology 78
for the processing of prescription drug and device claims. 79

       (2) Notwithstanding division (A)(1) of this section, this 80
section does not apply to the issuance or use of standardized 81
identification cards and other standardized technology for the 82
processing of prescription drug and device claims in connection 83
with any individual or group policy of sickness and accident 84
insurance covering only accident, credit, dental, disability 85
income, long-term care, hospital indemnity, medicare supplement, 86
medicare, tricare, specified disease, or vision care; coverage 87
under a one-time-limited-duration policy of not longer than six 88
months; coverage issued as a supplement to liability insurance; 89
insurance arising out of workers' compensation or similar law; 90
automobile medical payment insurance; or insurance under which 91
benefits are payable with or without regard to fault and which is 92
statutorily required to be contained in any liability insurance 93
policy or equivalent self-insurance. 94

       (3) Notwithstanding division (A)(1) of this section, this 95
section does not apply to the issuance or use of standardized 96
identification cards or other standardized technology for the 97
processing of prescription drug and device claims in connection 98
with coverage provided to beneficiaries enrolled in Title XIX of 99
the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, 100
as amended, known as the medical assistance program or medicaid, 101
by the department of job and family services under Chapter 5111. 102
of the Revised Code. 103

       (B) A standardized identification card or other standardized 104
technology issued or used by an insurer, or a person providing 105
managerial or administrative services for the insurer, as provided 106
in division (A) of this section shall contain uniform prescription 107
drug information that meets the requirements of either division 108
(B)(1) or (2) of this section. 109

        (1) The standardized identification card or other 110
standardized technology shall be in a format and contain 111
information fields approved by the national council for 112
prescription drug programs as contained in the council pharmacy 113
identification card implementation guide in effect on the first 114
day of October most immediately preceding the issuance of the 115
standardized identification card. 116

        (2) The standardized identification card or other 117
standardized technology shall contain any of the following 118
information if required for the processing of a claim: 119

        (a) The insurer's name; 120

        (b) The insured's name, group number, and identification 121
number; 122

       (c) A telephone number to inquire about pharmacy-related 123
issues; 124

        (d) The issuer's international identification number or "ANSI 125
BIN" number, labeled as "ANSI BIN" or "RxBIN"; 126

        (e) The processor's control number, labeled as "RxPCN"; 127

        (f) The insured's pharmacy benefits group number if different 128
than the insured's medical group number, labeled as "RxGrp." 129

        (C) If a standardized identification card or other 130
standardized technology issued under division (B)(2) of this 131
section is also used to process nonpharmacy claims, the use of the 132
designation "Rx" is not required in connection with the labels 133
identified in divisions (B)(2)(d) to (f) of this section. 134

        (D) Insurers, and persons providing managerial or 135
administrative services for insurers, shall not be required to 136
issue a standardized identification card or other standardized 137
technology with uniform prescription drug information to an 138
insured more than once during a twelve-month period. 139

        (E) Nothing in this section shall be construed as requiring 140
an insurer to produce more than one standardized identification 141
card or other standardized technology for use by insureds 142
accessing health care benefits provided under a policy of sickness 143
and accident insurance. 144

       Section 2. Section 1 of this act shall take effect one year 145
after the effective date of this act, and applies only to the 146
issuance and use of cards and other technology for the processing 147
of prescription drug and device claims in health care policies, 148
plans, and agreements that are delivered, issued for delivery, 149
renewed, or established on or after that date. 150

Section 1. That sections 1751.111 and 3923.601 of the Revised	7
Code be enacted to read as follows:	8

Sec. 1751.111. (A)(1) This section applies to every health	9
insuring corporation, and to every person contracted by the health	10
insuring corporation to provide managerial or administrative	11
services, that issues or requires the use of a standardized	12
identification card or other standardized technology for the	13
processing of prescription drug and device claims pursuant to a	14
policy, contract, or agreement for health care services.	15

(2) Notwithstanding division (A)(1) of this section, this	16
section does not apply to the issuance or use of standardized	17
identification cards or other standardized technology for the	18
processing of prescription drug and device claims in connection	19
with coverage provided to beneficiaries enrolled in Title XIX of	20
the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301,	21
as amended, known as the medical assistance program or medicaid,	22
by the department of job and family services under Chapter 5111.	23
of the Revised Code.	24

(B) A standardized identification card or other standardized	25
technology issued or used by a health insuring corporation, or a	26
person providing managerial or administrative services for the	27
health insuring corporation, as provided in division (A) of this	28
section shall contain uniform prescription drug information that	29
meets the requirements of either division (B)(1) or (2) of this	30
section.	31

(1) The standardized identification card or other	32
standardized technology shall be in a format and contain	33
information fields approved by the national council for	34
prescription drug programs as contained in the council pharmacy	35
identification card implementation guide in effect on the first	36
day of October most immediately preceding the issuance of the	37
standardized identification card.	38

(2) The standardized identification card or other	39
standardized technology shall contain any of the following	40
information if required for the processing of a claim:	41

(b) The enrollee's name, group number, and identification	43
number;	44

(c) A telephone number to inquire about pharmacy-related	45
issues;	46

(d) The issuer's international identification number or "ANSI	47
BIN" number, labeled as "ANSI BIN" or "RxBIN";	48

(f) The enrollee's pharmacy benefits group number if	50
different than the enrollee's medical group number, labeled as	51
"RxGrp."	52

(C) If a standardized identification card or other	53
standardized technology issued under division (B)(2) of this	54
section is also used to process nonpharmacy claims, the use of the	55
designation "Rx" is not required in connection with the labels	56
identified in divisions (B)(2)(d) to (f) of this section.	57

(D) Health insuring corporations, and persons providing	58
managerial or administrative services for health insuring	59
corporations, shall not be required to issue a standardized	60
identification card or other standardized technology with uniform	61
prescription drug information to an enrollee more than once during	62
a twelve-month period.	63

(E) Nothing in this section shall be construed as requiring a	64
health insuring corporation to produce more than one standardized	65
identification card or other standardized technology for use by	66
enrollees accessing health care benefits provided under a policy,	67
contract, or agreement for health care services.	68

Sec. 3923.601. (A)(1) This section applies to every sickness	69
and accident insurer, and to every person contracted by the	70
insurer to provide managerial or administrative services, that	71
issues or requires the use of a standardized identification card	72
or other standardized technology for the processing of	73
prescription drug and device claims pursuant to a policy of	74
sickness and accident insurance. This section also applies to	75
every pharmacy benefit manager, and to every health benefit plan	76
administered by the state, that issues or requires the use of a	77
standardized identification card or other standardized technology	78
for the processing of prescription drug and device claims.	79

(2) Notwithstanding division (A)(1) of this section, this	80
section does not apply to the issuance or use of standardized	81
identification cards and other standardized technology for the	82
processing of prescription drug and device claims in connection	83
with any individual or group policy of sickness and accident	84
insurance covering only accident, credit, dental, disability	85
income, long-term care, hospital indemnity, medicare supplement,	86
medicare, tricare, specified disease, or vision care; coverage	87
under a one-time-limited-duration policy of not longer than six	88
months; coverage issued as a supplement to liability insurance;	89
insurance arising out of workers' compensation or similar law;	90
automobile medical payment insurance; or insurance under which	91
benefits are payable with or without regard to fault and which is	92
statutorily required to be contained in any liability insurance	93
policy or equivalent self-insurance.	94

(3) Notwithstanding division (A)(1) of this section, this	95
section does not apply to the issuance or use of standardized	96
identification cards or other standardized technology for the	97
processing of prescription drug and device claims in connection	98
with coverage provided to beneficiaries enrolled in Title XIX of	99
the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301,	100
as amended, known as the medical assistance program or medicaid,	101
by the department of job and family services under Chapter 5111.	102
of the Revised Code.	103

(B) A standardized identification card or other standardized	104
technology issued or used by an insurer, or a person providing	105
managerial or administrative services for the insurer, as provided	106
in division (A) of this section shall contain uniform prescription	107
drug information that meets the requirements of either division	108
(B)(1) or (2) of this section.	109

(b) The insured's name, group number, and identification	121
number;	122

(f) The insured's pharmacy benefits group number if different	128
than the insured's medical group number, labeled as "RxGrp."	129

(D) Insurers, and persons providing managerial or	135
administrative services for insurers, shall not be required to	136
issue a standardized identification card or other standardized	137
technology with uniform prescription drug information to an	138
insured more than once during a twelve-month period.	139

(E) Nothing in this section shall be construed as requiring	140
an insurer to produce more than one standardized identification	141
card or other standardized technology for use by insureds	142
accessing health care benefits provided under a policy of sickness	143
and accident insurance.	144

Section 2. Section 1 of this act shall take effect one year	145
after the effective date of this act, and applies only to the	146
issuance and use of cards and other technology for the processing	147
of prescription drug and device claims in health care policies,	148
plans, and agreements that are delivered, issued for delivery,	149
renewed, or established on or after that date.	150