As Introduced

126th General Assembly Regular Session 2005-2006

H. B. No. 468

Representatives Hagan, Miller 

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A BILL

To amend sections 127.16, 2921.13, 5110.01, 5110.02,

1

5110.03, 5110.05, 5110.08, 5110.09, 5110.12,

2

5110.13, 5110.14, 5110.15, 5110.16, 5110.17,

3

5110.18, 5110.19, 5110.21, 5110.23, 5110.26,

4

5110.27, 5110.29, 5110.32, 5110.33, 5110.35,

5

5110.352, 5110.353, 5110.354, 5110.39, 5110.55,

6

5110.56, 5110.57, 5110.58, and 5110.59; to enact

7

section 5110.06 and new section 5110.11; and to

8

repeal sections 5110.10, 5110.11, 5110.22,

9

5110.28, and 5110.351 of the Revised Code to

10

modify the Ohio's Best Rx program.

11

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

Section 1. That sections 127.16, 2921.13, 5110.01, 5110.02,	12
5110.03, 5110.05, 5110.08, 5110.09, 5110.12, 5110.13, 5110.14,	13
5110.15, 5110.16, 5110.17, 5110.18, 5110.19, 5110.21, 5110.23,	14
5110.26, 5110.27, 5110.29, 5110.32, 5110.33, 5110.35, 5110.352,	15
5110.353, 5110.354, 5110.39, 5110.55, 5110.56, 5110.57, 5110.58,	16
and 5110.59 be amended and section 5110.06 and new section 5110.11	17
of the Revised Code be enacted to read as follows:	18

Sec. 127.16.  (A) Upon the request of either a state agency	19
or the director of budget and management and after the controlling	20
board determines that an emergency or a sufficient economic reason	21
exists, the controlling board may approve the making of a purchase	22
without competitive selection as provided in division (B) of this	23
section.	24

(B) Except as otherwise provided in this section, no state	25
agency, using money that has been appropriated to it directly,	26
shall:	27

(1) Make any purchase from a particular supplier, that would	28
amount to fifty thousand dollars or more when combined with both	29
the amount of all disbursements to the supplier during the fiscal	30
year for purchases made by the agency and the amount of all	31
outstanding encumbrances for purchases made by the agency from the	32
supplier, unless the purchase is made by competitive selection or	33
with the approval of the controlling board;	34

(2) Lease real estate from a particular supplier, if the	35
lease would amount to seventy-five thousand dollars or more when	36
combined with both the amount of all disbursements to the supplier	37
during the fiscal year for real estate leases made by the agency	38
and the amount of all outstanding encumbrances for real estate	39
leases made by the agency from the supplier, unless the lease is	40
made by competitive selection or with the approval of the	41
controlling board.	42

(C) Any person who authorizes a purchase in violation of	43
division (B) of this section shall be liable to the state for any	44
state funds spent on the purchase, and the attorney general shall	45
collect the amount from the person.	46

(D) Nothing in division (B) of this section shall be	47
construed as:	48

(1) A limitation upon the authority of the director of	49
transportation as granted in sections 5501.17, 5517.02, and	50
5525.14 of the Revised Code;	51

(2) Applying to medicaid provider agreements under Chapter	52
5111. of the Revised Code or payments or provider agreements under	53
the disability medical assistance program established under	54
Chapter 5115. of the Revised Code;	55

(3) Applying to the purchase of examinations from a sole	56
supplier by a state licensing board under Title XLVII of the	57
Revised Code;	58

(4) Applying to entertainment contracts for the Ohio state	59
fair entered into by the Ohio expositions commission, provided	60
that the controlling board has given its approval to the	61
commission to enter into such contracts and has approved a total	62
budget amount for such contracts as agreed upon by commission	63
action, and that the commission causes to be kept itemized records	64
of the amounts of money spent under each contract and annually	65
files those records with the clerk of the house of representatives	66
and the clerk of the senate following the close of the fair;	67

(5) Limiting the authority of the chief of the division of	68
mineral resources management to contract for reclamation work with	69
an operator mining adjacent land as provided in section 1513.27 of	70
the Revised Code;	71

(6) Applying to investment transactions and procedures of any	72
state agency, except that the agency shall file with the board the	73
name of any person with whom the agency contracts to make, broker,	74
service, or otherwise manage its investments, as well as the	75
commission, rate, or schedule of charges of such person with	76
respect to any investment transactions to be undertaken on behalf	77
of the agency. The filing shall be in a form and at such times as	78
the board considers appropriate.	79

(7) Applying to purchases made with money for the per cent	80
for arts program established by section 3379.10 of the Revised	81
Code;	82

(8) Applying to purchases made by the rehabilitation services	83
commission of services, or supplies, that are provided to persons	84
with disabilities, or to purchases made by the commission in	85
connection with the eligibility determinations it makes for	86
applicants of programs administered by the social security	87
administration;	88

(9) Applying to payments by the department of job and family	89
services under section 5111.13 of the Revised Code for group	90
health plan premiums, deductibles, coinsurance, and other	91
cost-sharing expenses;	92

(10) Applying to any agency of the legislative branch of the	93
state government;	94

(11) Applying to agreements or contracts entered into under	95
section 5101.11, 5101.20, 5101.201, 5101.21, or 5101.214 of the	96
Revised Code;	97

(12) Applying to purchases of services by the adult parole	98
authority under section 2967.14 of the Revised Code or by the	99
department of youth services under section 5139.08 of the Revised	100
Code;	101

(13) Applying to dues or fees paid for membership in an	102
organization or association;	103

(14) Applying to purchases of utility services pursuant to	104
section 9.30 of the Revised Code;	105

(15) Applying to purchases made in accordance with rules	106
adopted by the department of administrative services of motor	107
vehicle, aviation, or watercraft fuel, or emergency repairs of	108
such vehicles;	109

(16) Applying to purchases of tickets for passenger air	110
transportation;	111

(17) Applying to purchases necessary to provide public	112
notifications required by law or to provide notifications of job	113
openings;	114

(18) Applying to the judicial branch of state government;

115

(19) Applying to purchases of liquor for resale by the	116
division of liquor control;	117

(20) Applying to purchases of motor courier and freight	118
services made in accordance with department of administrative	119
services rules;	120

(21) Applying to purchases from the United States postal	121
service and purchases of stamps and postal meter replenishment	122
from vendors at rates established by the United States postal	123
service;	124

(22) Applying to purchases of books, periodicals, pamphlets,	125
newspapers, maintenance subscriptions, and other published	126
materials;	127

(23) Applying to purchases from other state agencies,	128
including state-assisted institutions of higher education;	129

(24) Limiting the authority of the director of environmental	130
protection to enter into contracts under division (D) of section	131
3745.14 of the Revised Code to conduct compliance reviews, as	132
defined in division (A) of that section;	133

(25) Applying to purchases from a qualified nonprofit agency	134
pursuant to sections 125.60 to 125.6012 or 4115.31 to 4115.35 of	135
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 (B) of section 5126.056 of	169
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 entersentered into with terminal distributors of	175
dangerous drugs 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

(15) The statement is made in an application filed with a	247
county sheriff pursuant to section 2923.125 of the Revised Code in	248
order to obtain or renew a license to carry a concealed handgun or	249
is made in an affidavit submitted to a county sheriff to obtain a	250
temporary emergency license to carry a concealed handgun under	251
section 2923.1213 of the Revised Code.	252

(16) The statement is required under section 5743.72 of the	253
Revised Code in connection with the person's purchase of	254
cigarettes or tobacco products in a delivery sale.	255

(B) No person, in connection with the purchase of a firearm,	256
as defined in section 2923.11 of the Revised Code, shall knowingly	257
furnish to the seller of the firearm a fictitious or altered	258
driver's or commercial driver's license or permit, a fictitious or	259
altered identification card, or any other document that contains	260
false information about the purchaser's identity.	261

(C) No person, in an attempt to obtain a license to carry a	262
concealed handgun under section 2923.125 of the Revised Code,	263
shall knowingly present to a sheriff a fictitious or altered	264
document that purports to be certification of the person's	265
competence in handling a handgun as described in division (B)(3)	266
of section 2923.125 of the Revised Code.	267

(D) It is no defense to a charge under division (A)(6) of	268
this section that the oath or affirmation was administered or	269
taken in an irregular manner.	270

(E) If contradictory statements relating to the same fact are	271
made by the offender within the period of the statute of	272
limitations for falsification, it is not necessary for the	273
prosecution to prove which statement was false but only that one	274
or the other was false.	275

(F)(1) Whoever violates division (A)(1), (2), (3), (4), (5),	276
(6), (7), (8), (10), (11), (13), (14), or (16) of this section is	277
guilty of falsification, a misdemeanor of the first degree.	278

(2) Whoever violates division (A)(9) of this section is	279
guilty of falsification in a theft offense. Except as otherwise	280
provided in this division, falsification in a theft offense is a	281
misdemeanor of the first degree. If the value of the property or	282
services stolen is five hundred dollars or more and is less than	283
five thousand dollars, falsification in a theft offense is a	284
felony of the fifth degree. If the value of the property or	285
services stolen is five thousand dollars or more and is less than	286
one hundred thousand dollars, falsification in a theft offense is	287
a felony of the fourth degree. If the value of the property or	288
services stolen is one hundred thousand dollars or more,	289
falsification in a theft offense is a felony of the third degree.	290

(3) Whoever violates division (A)(12) or (B) of this section	291
is guilty of falsification to purchase a firearm, a felony of the	292
fifth degree.	293

(4) Whoever violates division (A)(15) or (C) of this section	294
is guilty of falsification to obtain a concealed handgun license,	295
a felony of the fourth degree.	296

(G) A person who violates this section is liable in a civil	297
action to any person harmed by the violation for injury, death, or	298
loss to person or property incurred as a result of the commission	299
of the offense and for reasonable attorney's fees, court costs,	300
and other expenses incurred as a result of prosecuting the civil	301
action commenced under this division. A civil action under this	302
division is not the exclusive remedy of a person who incurs	303
injury, death, or loss to person or property as a result of a	304
violation of this section.	305

Sec. 5110.01.  As used in this chapter:

306

(A) "Administrative fee" means the amount specified in rules	307
adopted under division (G) of section 5110.35 of the Revised Code.	308

(B) "Children's health insurance program" means the	309
children's health insurance program part I and part II established	310
under sections 5101.50 to 5101.5110 of the Revised Code.	311

(C)(B) "Disability medical assistance program" means the	312
program established under section 5115.10 of the Revised Code.	313

(D)(C) "Medicaid program" or "medicaid" means the medical	314
assistance program established under Chapter 5111. of the Revised	315
Code.	316

(E)(D) "National drug code number" means the number	317
registered for a drug pursuant to the listing system established	318
by the United States food and drug administration under the "Drug	319
Listing Act of 1972," 86 Stat. 559, 21 U.S.C. 360, as amended.	320

(F) "Ohio's best Rx program administrator" means the entity,	321
if any, the department of job and family services contracts with	322
pursuant to section 5110.10 of the Revised Code to perform	323
administrative functions of the Ohio's best Rx program and to	324
offer the mail order system through which Ohio's best Rx program	325
participants may obtain drugs by mail.	326

(G) "Ohio's best Rx program applicant" or "applicant" means	327
an individual who signs an application for the Ohio's best Rx	328
program and submits it to the department of job and family	329
services, or the Ohio's best Rx program administrator, for a	330
determination of eligibility for the program.	331

(H)(E) "Ohio's best Rx program participant" or "participant"	332
means an individual determined eligible for the Ohio's best Rx	333
program and included under a valid Ohio's best Rx program	334
enrollment card.	335

(I)(F) "Ohio's best Rx program price" means the price a	336
participating terminal distributor is to charge, as determined	337
under section 5110.14 of the Revised Code, that an Ohio's best Rx	338
program participant is to be charged for a drug included in the	339
Ohio's best Rx program as determined under section 5110.14 of the	340
Revised Code. "Ohio's best Rx program price" does not include	341
either of the following:	342

(1) TheIn the case of a drug dispensed by a participating	343
terminal distributor, the amount of the professional fee, if any,	344
the participating terminal distributor adds to the Ohio's best Rx	345
program price pursuant to an agreement entered into under section	346
5110.12 of the Revised Code;	347

(2) TheIn the case of a drug dispensed by a participating	348
terminal distributor or the drug mail order system included in the	349
program pursuant to section 5110.11 of the Revised Code, the	350
amount of the administrative fee, if any, the department of job	351
and family services reports to the participating terminal	352
distributordetermines in rules adopted under section 5110.29	353
5110.35 of the Revised Code.	354

(J)(G) "Participating manufacturer" means a drug manufacturer	355
participating in the Ohio's best Rx program pursuant to a rebate	356
manufacturer agreement entered into under section 5110.21 of the	357
Revised Code.	358

(K)(H) "Participating terminal distributor" means a terminal	359
distributor of dangerous drugs participating in the Ohio's best Rx	360
program pursuant to an agreement entered into with the department	361
of job and family services under section 5110.12 of the Revised	362
Code.	363

(L)(I) "Per unit price," with regard to a state health	364
benefit plan or state retirement system health benefit plan, means	365
the total amount paid to a terminal distributor of dangerous drugs	366
under a state health benefit plan or state retirement system	367
health benefitthe plan for one unit of a drug covered by the	368
plan, after the plan discounts or otherwise reduces the amount to	369
be paid to the terminal distributor. "Per unit price" does not	370
include any amount paid to the terminal distributor of dangerous	371
drugs under the plan as an administrative fee for dispensing the	372
drug, but includes both of the following:	373

(1) The amount that the state health benefit plan or state	374
retirement system health benefit plan, or other government entity	375
or person authorized to make the payment on behalf of the plan,	376
pays to the terminal distributor of dangerous drugs;	377

(2) The amount that the beneficiary of the state health	378
benefit plan or state retirement system health benefit plan pays	379
to the terminal distributor of dangerous drugs in the form of a	380
copayment, coinsurance, or other cost-sharing charge.	381

(M)(J) "Per unit rebate," with regard to a state health	382
benefit plan or state retirement system health benefit plan, means	383
all rebates, discounts, formulary fees, administrative fees, and	384
other allowances a drug manufacturer pays to the plan, or other	385
government entity or person authorized to receive all or part of	386
such payments, for a drug during a calendar year, divided by the	387
total number of units of that drug dispensed under the plan during	388
the same calendar year.	389

(N) "Rebate administration percentage" means the percentage	390
specified in rules adopted under division (K) of section 5110.35	391
of the Revised Code.	392

(O) "Rebate agreement" means an agreement under section	393
5110.21 of the Revised Code between the department of job and	394
family services and a drug manufacturer.	395

(P)(K) "State health benefit plan" means a program of health	396
care benefits offered through the Ohio med preferred provider	397
organization, or a successor entity selected by the state, to	398
which either of the following applyapplies:	399

(1) It is provided by a collective bargaining agreement	400
authorized by division (A)(4) of section 4117.03 of the Revised	401
Code.	402

(2) It is offered by the department of administrative	403
services to state employees in accordance with section 124.81 or	404
124.82 of the Revised Code.	405

(Q)(L) "State retirement system" means all of the following:	406
the public employees retirement system, state teachers retirement	407
system, school employees retirement system, Ohio police and fire	408
pension fund, and state highway patrol retirement system.	409

(R)(M) "State retirement system health benefit plan" means a	410
plan of health care benefits offered by a state retirement system	411
under section 145.58, 742.45, 3307.39, 3309.69, or 5505.28 of the	412
Revised Code.	413

(S)(N) "Terminal distributor of dangerous drugs" has the same	414
meaning as in section 4729.01 of the Revised Code.	415

(T)(O) "Third-party payer" has the same meaning as in section	416
3901.38 of the Revised Code.	417

(U)(P) "Trade secret" has the same meaning as in section	418
1333.61 of the Revised Code.	419

(V)(Q) "Usual and customary charge" means the amount a	420
participating terminal distributor or the Ohio's best Rx program	421
administratordrug mail order system included in the Ohio's best	422
Rx program pursuant to section 5110.11 of the Revised Code charges	423
forwhen a drug included in the program tois purchased by an	424
individual who does not receive a discounted price for the drug	425
pursuant to any drug discount program, including the Ohio's best	426
Rx program, a prescription drug discount card program established	427
under section 173.061 of the Revised Code, or a pharmacy	428
assistance program established by any person or government entity,	429
and for whom no third-party payer or program funded in whole or	430
part with state or federal funds is responsible for all or part of	431
the cost of the drug the distributor dispenses to the individual.	432

Sec. 5110.02. (A) There is hereby established the Ohio's best	433
Rx program. Except as provided in division (B) of this section	434
5110.10 of the Revised Code, the department of job and family	435
services shall administer the program.	436

(B)(1) The department may enter into a contract with any	437
person under which the person serves as the administrator of the	438
Ohio's best Rx program. Before entering into a contract for a	439
program administrator, the department shall issue a request for	440
proposals from persons seeking to be considered. The department	441
shall develop a process to be used in issuing the request for	442
proposals, receiving responses to the request, and evaluating the	443
responses on a competitive basis. In accordance with that process,	444
the department shall select the person to be awarded the contract.	445

(2) Subject to divisions (B)(4) and (5) of this section, the	446
department may delegate to the person awarded the contract any of	447
the department's powers or duties specified in this chapter or any	448
other provision of the Revised Code pertaining to the Ohio's best	449
Rx program. The terms of the contract shall specify the extent to	450
which the powers or duties are delegated to the program	451
administrator.	452

(3) In exercising powers or performing duties delegated under	453
the contract, the program administrator is subject to the same	454
provisions of this chapter or other provisions of the Revised Code	455
that grant the powers or duties to the department, as well as any	456
limitations or restrictions that are applicable to or associated	457
with those powers or duties. Wherever the department is referred	458
to in this chapter or another provision of the Revised Code	459
relative to a power or duty delegated to the program	460
administrator, both of the following are the case:	461

(a) If the department has delegated the power or duty in	462
whole to the program administrator, the reference to the	463
department is, instead, a reference to the administrator.	464

(b) If the department retains any part of the power or duty	465
that is delegated to the program administrator, the reference to	466
the department is a reference to both the department and the	467
administrator.	468

(4) The terms of a contract for a program administrator shall	469
include provisions for offering the drug mail order system	470
included in the Ohio's best Rx program pursuant to section 5110.11	471
of the Revised Code. The terms of the contract may permit the	472
administrator to offer the drug mail order system by contracting	473
with another person.	474

(5) The department shall not delegate to a program	475
administrator authority to do any of the following:	476

(a) Enter into contracts under this section other than a	477
contract to offer a drug mail order system;	478

(b) Adopt rules under section 5110.35 or 5110.36 of the	479
Revised Code;	480

(c) Employ an ombudsperson pursuant to section 5110.40 of the	481
Revised Code.	482

Sec. 5110.03.  (A) Except as provided in division (B) of this	483
section, a drug shall be included in the Ohio's best Rx program if	484
the drug is covered by a state health benefit plan or state	485
retirement system health benefit plan or is covered byincluded in	486
a rebatemanufacturer agreement entered into under section 5110.21	487
of the Revised Code.	488

(B) The department of job and family services may exclude	489
from the program a drug covered by a state health benefit plan or	490
state retirement system health benefit plan if the plan receives a	491
rebate for the drug from the manufacturer but the drug is not	492
covered byincluded in a rebatemanufacturer agreement entered	493
into under section 5110.21 of the Revised Code.	494

Sec. 5110.05. (A) To be eligible for the Ohio's best Rx	495
program, an individual must meet all of the following requirements	496
at the time of application or reapplication for the program:	497

(1) BeThe individual must be a resident of this state;.

498

(2) HaveEither of the following must be the case:

499

(a) The individual has family income, as determined under	500
rules adopted pursuant to section 5110.35 of the Revised Code,	501
that does not exceed twothree hundred fifty per cent of the	502
federal poverty guidelines, as revised annually by the United	503
States department of health and human services in accordance with	504
section 673(2) of the "Omnibus Budget Reconciliation Act of 1981,"	505
95 Stat. 511, 42 U.S.C. 9902, as amended, or be;	506

(b) The individual is sixty years of age or older;.

507

(3) NotExcept as provided in division (B) of this section,	508
the individual must not have coverage for outpatient prescription	509
drug coveragedrugs paid for in whole or in part by any of the	510
following:	511

(a) A third-party payer;

512

(b) An employer;

513

(c) The medicaid program;

514

(c)(d) The children's health insurance program;

515

(d)(e) The disability medical assistance program;

516

(e)(f) Another health plan or pharmacy assistance program	517
that uses state or federal funds to pay part or all of the cost of	518
the individual's outpatient prescription drugs, other than a	519
prescription drug discount card program established under section	520
173.061 of the Revised Code.	521

(4) NotThe individual must not have had coverage for	522
outpatient prescription drug coveragedrugs paid for by any of the	523
entities or programs specified in division (A)(3) of this section	524
during any of the four months preceding the month in which the	525
application or reapplication for the Ohio's best Rx program is	526
made, unless any of the following applies:	527

(a) The individual is sixty years of age or older.

528

(b) The third-party payer or employer that paid all or part	529
offor the coverage filed for bankruptcy under federal bankruptcy	530
laws.	531

(c) The individual is no longer eligible for coverage	532
provided through a retirement plan subject to protection under the	533
"Employee Retirement Income Security Act of 1974," 88 Stat. 832,	534
29 U.S.C. 1001, as amended.	535

(d) The individual is no longer eligible for the medicaid	536
program, children's health insurance program, or disability	537
medical assistance program.	538

(e) The individual is either temporarily or permanently	539
discharged from employment due to a business reorganization.	540

(B) Application and annual reapplication for the Ohio's best	541
Rx program shall be made in accordance with rules adopted under	542
section 5110.35 of the Revised Code on a form prescribed in those	543
rules. An individual may apply or reapply on behalf of the	544
individual and the individual's spouse and children. The guardian	545
or custodian of an individual may apply or reapply on behalf of	546
the individualAn individual is not subject to division (A)(3) of	547
this section if the individual has coverage for outpatient drugs	548
paid for in whole or in part by any of the following:	549

(1) A prescription drug discount card program established	550
under section 173.061 of the Revised Code;	551

(2) The workers' compensation program;

552

(3) A medicare prescription drug plan offered pursuant to the	553
"Medicare Prescription Drug, Improvement, and Modernization Act of	554
2003," 117 Stat. 2071, 42 U.S.C. 1395w-101, as amended, but only	555
if all of the following are the case with respect to the	556
particular drug being purchased through the Ohio's best Rx	557
program:	558

(a) The individual is responsible for the full cost of the	559
drug.	560

(b) The drug is not subject to a rebate from the manufacturer	561
under the individual's medicare prescription drug plan.	562

(c) The manufacturer of the drug has agreed to the Ohio's	563
best Rx program's inclusion of individuals who have coverage	564
through a medicare prescription drug plan.	565

Sec. 5110.06. Application and annual reapplication for the	566
Ohio's best Rx program shall be made in accordance with rules	567
adopted by the department of job and family services under section	568
5110.35 of the Revised Code. An individual may apply or reapply on	569
behalf of the individual and the individual's spouse and children.	570
The guardian or custodian of an individual may apply or reapply on	571
behalf of the individual.	572

When submitting an application, the applicant shall include	573
the information and documentation specified in the department's	574
rules as necessary to verify eligibility for the program. The	575
application may be submitted on a paper form prescribed and	576
supplied by the department or pursuant to any other application	577
method the department makes available for the program, including	578
methods that permit an individual to apply by telephone or through	579
the internet.	580

An applicant shall attest that the information and	581
documentation the applicant submits with an application is	582
accurate to the best knowledge and belief of the applicant. In the	583
case of a paper application form, the applicant's signature shall	584
be used to certify that the applicant has attested to the accuracy	585
of the information and documentation. In the case of other	586
application methods, the application certification process	587
specified in the department's rules shall be used to certify that	588
the applicant has attested to the accuracy of the information and	589
documentation.	590

The department shall inform each applicant that knowingly	591
making a false statement in an application is falsification under	592
section 2921.13 of the Revised Code, a misdemeanor of the first	593
degree. In the case of a paper application form, the department	594
shall provide the information by including on the form a statement	595
printed in bold letters.	596

Sec. 5110.08. On receipt of applications and annual	597
reapplications, the department of job and family services shall	598
make eligibility determinations for the Ohio's best Rx program in	599
accordance with procedures established in rules adopted under	600
section 5110.35 of the Revised Code. Each determination that an	601
individual is eligible is valid for one year beginning on a date	602
determined in accordance with the eligibility determination	603
procedures. The beginning date may not precede the date on which	604
the individual's eligibility is determined. Annual reapplication	605
may be made under division (B) of section 5110.055110.06 of the	606
Revised Code if the individual seeks to continue to participate in	607
the program after the date eligibility would otherwise end.	608

An eligibility determination under this section may not be	609
appealed under Chapter 119., section 5101.35, or any other	610
provision of the Revised Code.	611

Sec. 5110.09. (A) The department of job and family services	612
shall issue Ohio's best Rx program enrollment cards to or on	613
behalf of individuals determined eligible to participate. One	614
enrollment card may cover each member of a family determined	615
eligible to participate. The card is valid only during the period	616
each individual covered by the card is eligible to participate.	617
The card shall be presented to a participating terminal	618
distributor each	619

(B) Each time a drug included in the program is purchased	620
under the program, the eligibility of the participant for whom the	621
drug is dispensed shall be confirmed through the department. If	622
the drug is being purchased from a participating terminal	623
distributor and the participant's enrollment card is available for	624
presentation at the time of the purchase, the purchaser shall	625
present the enrollment card to the participating terminal	626
distributor.	627

Sec. 5110.11. (A) For purposes of making drugs included in	628
the Ohio's best Rx program available to participants by mail, the	629
department of job and family services shall include a drug mail	630
order system within the program. Not more than one drug mail order	631
system shall be included in the program. The program's drug mail	632
order system shall be provided in accordance with rules adopted	633
under section 5110.35 of the Revised Code.	634

(B)(1) When a drug included in the program is dispensed to a	635
participant through the program's drug mail order system, the	636
amount the participant is charged for the drug shall be the lesser	637
of the following:	638

(a) The sum of the Ohio's best Rx program price applicable to	639
the system and the administrative fee, if any, in an amount	640
determined in accordance with rules adopted under section 5110.35	641
of the Revised Code;	642

(b) The system's usual and customary charge.

643

(2) A participant shall not be charged a professional fee	644
when a drug included in the program is dispensed to the	645
participant through the program's drug mail order system.	646

Sec. 5110.12. A(A) For purposes of making drugs included in	647
the Ohio's best Rx program available to participants from terminal	648
distributors of dangerous drugs other than the drug mail order	649
system included in the program pursuant to section 5110.11 of the	650
Revised Code, the department of job and family services shall	651
enter into agreements under this section with terminal	652
distributors of dangerous drugs. Any terminal distributor of	653
dangerous drugs may enter into an agreement with the department of	654
job and family services to participate in the Ohio's best Rx	655
program for purposes of dispensing drugspursuant to this section.	656
Before	657

Before entering into an agreement under this section with a	658
terminal distributor, the department shall provide the terminal	659
distributor with a formula that allows the terminal distributor to	660
calculate the price of each drug included in the program, a	661
statistically valid sampling of drug prices that includes the	662
prices of not less than two branded and two generic drugs from	663
each category of drugs included in the program, or the current	664
Ohio's best Rx program price for each drug included in the	665
program.	666

(B) An agreement entered into under this section shall do all	667
of the following:	668

(A)(1) Except as provided in division (C)(B)(3) of this	669
section, be in effect for not less than one year;	670

(B)(2) Specify the dates that the agreement is to begin and	671
end;	672

(C)(3) Permit the participating terminal distributor to	673
terminate the agreement before the date the agreement would	674
otherwise end as specified pursuant to division (B)(2) of this	675
section by providing the department notice of early termination at	676
least thirty days before the effective date of the early	677
termination;	678

(D)(4) Require that the participating terminal distributor	679
charge an Ohio's best Rx program participant for each drug	680
included in the program the lesser of (1)(a) the sum of the Ohio's	681
best Rx program price as determined under section 5110.14 of the	682
Revised Codeapplicable to participating terminal distributors,	683
the professional fee permitted under division (E)(B)(5) of this	684
section, if any, and the administrative fee under division	685
(F)(B)(6) of this section, if any, or (2)(b) the terminal	686
distributor's usual and customary charge;	687

(E)(5) Permit the participating terminal distributor to add	688
to the Ohio's best Rx program price a professional fee in an	689
amount not to exceed, except as provided in rules adopted under	690
section 5110.35 of the Revised Code, three dollars;	691

(F)(6) Require the participating terminal distributor to add	692
to the Ohio's best Rx program price an administrative fee, in an	693
amount determined in accordance with rules adopted under section	694
5110.35 of the Revised Code, for each transaction in which a	695
quantity of the drug is dispensed if an administrative fee is	696
required by those rules;	697

(G)(7) Require the participating terminal distributor to	698
disclose to each participant the amount the participant saves	699
under the program as determined in accordance with section 5110.15	700
of the Revised Code;	701

(H)(8) Require the participating terminal distributor to	702
submit a claim to the department under section 5110.16 of the	703
Revised Code for each sale of a drug to a participant;	704

(I)(9) Permit the participating terminal distributor to	705
deliver drugs to Ohio's best Rx program participants by mail, but	706
not by using a drug mail order system operated in the same manner	707
as the system included in the Ohio's best Rx program pursuant to	708
section 5110.11 of the Revised Code.	709

Sec. 5110.13. The department of job and family services may	710
not prohibit aA terminal distributor of dangerous drugs shall not	711
be prohibited from participating in any other program the	712
department administersor any network of health care providers on	713
the basis that the terminal distributor has not entered into an	714
agreement under section 5110.12 of the Revised Code to participate	715
in the Ohio's best Rx program.	716

No entity under contract with the department under section	717
5110.10 of the Revised Code may prohibit a terminal distributor of	718
dangerous drugs from participating in a program or network the	719
entity administers or operates on the basis that the terminal	720
distributor has not entered into an agreement under section	721
5110.12 of the Revised Code.	722

Sec. 5110.14.  The Ohio's best Rx program price for a drug	723
included in the program, as described in section 5110.03 of the	724
Revised Code, shall be determined as follows:	725

(A) When the drug is dispensed through a participating	726
terminal distributor, the price shall be determined by multiplying	727
the number of units of the drug a participating terminal	728
distributor dispensesdispensed to a participant by whichever of	729
the following is applicable:	730

(A)(1) If the drug is not subject toincluded in a rebate	731
manufacturer agreement entered into under section 5110.21 of the	732
Revised Code, the amount computed under division (A)(1) or (2) of	733
section 5110.27 of the Revised Code, as applicable;	734

(B)(2) If the drug is subject toincluded in a rebate	735
manufacturer agreement entered into under section 5110.21 of the	736
Revised Code, the amount computed under division (C) of section	737
5110.27 of the Revised Code.	738

(B) When the drug is dispensed through the drug mail order	739
system included in the program pursuant to section 5110.11 of the	740
Revised Code, the price shall be an amount not exceeding the price	741
that would be charged for the same drug pursuant to division	742
(A)(1) or (2) of this section. The amount that may be charged	743
under this division is subject to the rules adopted under section	744
5110.35 of the Revised Code governing the drug mail order system.	745

Sec. 5110.15. The amount that an Ohio's best Rx program	746
participant saves under the program on a transaction for a drug	747
included in the program shall be determined by subtracting the sum	748
of the following from the usual and customary charge for that	749
quantity of the drug the participating terminal distributor or	750
Ohio's best Rx program administrator dispensesdispensed to the	751
participant by the participating terminal distributor or the drug	752
mail order system included in the program pursuant to section	753
5110.11 of the Revised Code:	754

(A) The Ohio's best Rx program price multiplied by the number	755
of units of the drug dispensedthat applies to the transaction;	756

(B) TheWhen the transaction occurs through a participating	757
terminal distributor rather than the program's drug mail order	758
system, the professional fee, if any, the distributor or	759
administrator is permitted to charge pursuant to an agreement	760
entered into under section 5110.12 of the Revised Code or a	761
contract under section 5110.10 of the Revised Code;	762

(C) The administrative fee, if any, the department of job and	763
family services reports to the distributor or administrator	764
specifies in rules adopted under section 5110.295110.35 of the	765
Revised Code.	766

Sec. 5110.16. A participating terminal distributor or the	767
Ohio's best Rx program administrator shall submit a claim shall be	768
submitted to the department of job and family services for each	769
drug dispensed to an Ohio's best Rx program participant. The	770
participating terminal distributor or the drug mail order system	771
included in the program pursuant to section 5110.11 of the Revised	772
Code that dispensed the drug shall submit the claim not later than	773
thirty days after the drug is dispensed. The claim shall be	774
submitted in accordance with the electronic method provided for in	775
rules adopted under section 5110.35 of the Revised Code.	776

The claim shall specify all of the following:

777

(A) The prescription number of the participant's prescription	778
under which the drug is dispensed to the participant;	779

(B) The name of, and national drug code number for, the drug	780
dispensed to the participant;	781

(C) The number of units of the drug dispensed to the	782
participant;	783

(D) The amount the distributor or administrator charged the	784
participant was charged for the drug;	785

(E) The date that the distributor or administrator dispensed	786
the drug was dispensed to the participant;	787

(F) Any additional information required by rules adopted	788
under section 5110.35 of the Revised Code.	789

Sec. 5110.17. (A) In accordance with rules adopted under	790
section 5110.35 of the Revised Code and subject to section 5110.19	791
of the Revised Code, the department of job and family services	792
shall pay a participating terminal distributor or the Ohio's best	793
Rx program administratormake payments under the Ohio's best Rx	794
program for complete and timely claims submitted under section	795
5110.16 of the Revised Code for drugs included in the program that	796
are covered byalso included in a rebatemanufacturer agreement	797
entered into under section 5110.21 of the Revised Code. The	798
payment for a complete and timely claim shall be made by a date	799
that is not later than two weeks after the claim is received by	800
the department receives the claim from the participating terminal	801
distributor or the drug mail order system included in the program	802
pursuant to section 5110.11 of the Revised Code.	803

(B) Subject to division (D) of this section, the amount to be	804
paid for a claim shall be determined as follows:	805

(1) Multiply the rebatemanufacturer payment amount for the	806
national drug code number for the drug for which the claim is	807
made, as agreed to under division (B)(4)(a)(D)(1) of section	808
5110.21 of the Revised Code or computed under division (B) of	809
section 5110.27 of the Revised Code, as applicable, by the number	810
of units of the drug dispensed to the Ohio's best Rx program	811
participant;	812

(2) If rules adopted under section 5110.35 of the Revised	813
Code require that program participants be charged an	814
administrative fee was charged, for each transaction in which a	815
quantity of the drug was dispensed, subtract from the amount	816
computed under division (B)(1) of this section the administrative	817
fee amount specified in those rules adopted under section 5110.35	818
of the Revised Code.	819

(C) The department may combine the claims fromsubmitted by a	820
participating terminal distributor or the administratorprogram's	821
drug mail order system to make aggregate payments under this	822
section to the distributor or administratorsystem.	823

(D) If the total of the amounts computed under division (B)	824
of this section for any period for which payments are due is a	825
negative number, the participating terminal distributor or	826
administratorthe program's drug mail order system that submitted	827
the claims has been overpaid for the claims submitted under	828
section 5110.16 of the Revised Code. When there is an overpayment,	829
the department shall reduce future payments to the terminal	830
distributor or administratormade under this section to the	831
distributor or system or collect an amount from the terminal	832
distributor or administratorsystem sufficient to reimburse the	833
department for the overpayment.	834

Sec. 5110.18.  Neither the department of job and family	835
services nor the Ohio's best Rx program administrator may charge a	836
participating terminal distributor nor the drug mail order system	837
included in the Ohio's best Rx program pursuant to section 5110.11	838
of the Revised Code may be charged by the department of job and	839
family services for the submission or processing of a claim under	840
sections 5110.16 and 5110.17 of the Revised Code.	841

Sec. 5110.19. The department of job and family services may	842
not make a payment under section 5110.17 of the Revised Code for a	843
claim submitted under section 5110.16 of the Revised Code if any	844
of the following are the case:	845

(A) The claim is submitted by either a terminal distributor	846
of dangerous drugs that is neithernot a participating terminal	847
distributor nor the Ohio's best Rx program administratoror a drug	848
mail order system that is not the system included in the Ohio's	849
best Rx program pursuant to section 5110.11 of the Revised Code.	850

(B) The claim is for a drug that is not included in the	851
program.	852

(C) The claim is for a drug included in the program but the	853
drug is dispensed to an individual who is not covered by a valid	854
Ohio's best Rx program enrollment card.	855

(D) A person or government entity has paid the participating	856
terminal distributor or the administratorprogram's drug mail	857
order system through any other prescription drug coverage program	858
or prescription drug discount program for dispensing the drug,	859
unless the payment is reimbursement for redeeming a coupon or is	860
an amount directly paid by a drug manufacturer to the terminal	861
distributor or system for dispensing drugs to residents of a	862
long-term care facility.	863

Sec. 5110.21.  (A) AFor purposes of participating in the	864
Ohio's best Rx program, any drug manufacturer may enter into a	865
rebatean agreement under this section with the department of job	866
and family services regarding drugs it manufactures. The agreement	867
shall specify the time it is to be in effect, which shall be not	868
less than one year from the date the agreement is entered into.	869

(B) The agreement shall do all of the following:

870

(1) Specify which of the manufacturer's drugs are included in	871
the agreement;	872

(2) Permit the department to remove a drug from the agreement	873
in the event of a dispute over the drug's utilization;	874

(3) Require that the manufacturer make a rebate payment to	875
the department in an amount that complies with division (D) of	876
this section for each drug specified under division (B)(1) of this	877
sectionincluded in the agreement that is dispensed to an Ohio's	878
best Rx program participant;	879

(4)(a) Require that the per unit rebate be in an amount equal	880
to the greater of the following:	881

(i) The weighted average of the per unit rebates for the drug	882
as computed under division (C)(1) of this section;	883

(ii) A per unit amount specified by the manufacturer.

884

(b) Require that the rebate payment for a quantity of a drug	885
dispensed to an Ohio's best Rx participant be equal to the amount	886
determined by multiplying the applicable per unit rebate by the	887
number of units dispensed.	888

(5) Specify the intervals at which the manufacturer will	889
report to the department amounts specified pursuant to division	890
(B)(4)(a)(ii) of this section;	891

(6) Require that the manufacturer make the rebate payments to	892
the department on a quarterly basis or in accordance with a	893
schedule established by rules adopted under section 5110.35 of the	894
Revised Code.	895

(C) For each drug included in the agreement, the agreement	896
may establish a process for referring Ohio's best Rx program	897
applicants to patient assistance programs operated by the	898
manufacturer if the manufacturer agrees to refer to the Ohio's	899
best Rx program residents of this state who apply but are	900
ineligible for the manufacturer's patient assistance programs.	901

(D)(1) The manufacturer's per unit payment to the department	902
for a drug included in the agreement shall be an amount equal to	903
the greater of the following:	904

(a) The weighted average of the per unit rebates for the	905
drug, as computed under division (E)(1) of this section;	906

(b) Subject to division (D)(3) of this section, a per unit	907
amount specified by the manufacturer.	908

(2) The payment for a quantity of a drug dispensed to an	909
Ohio's best Rx program participant shall be equal to the amount	910
determined by multiplying the per unit payment applicable under	911
division (D)(1) of this section by the number of units dispensed.	912

(3) In the case of an agreement under which the manufacturer	913
specifies a per unit amount for a drug, all of the following	914
apply:	915

(a) The agreement shall specify the intervals at which the	916
manufacturer will report the per unit amount to the department.	917

(b) If a computation cannot be made under division (E)(1) of	918
this section because the department has not received the necessary	919
information to make the computation, the manufacturer shall use	920
its best efforts to ensure that it specifies a per unit amount for	921
the drug that is equal to or greater than its estimate of the	922
average of the per unit rebates for the drug.	923

(c) If a computation is not made under division (E)(1) of	924
this section but can be made within twelve months after the	925
manufacturer enters into the agreement, and the computation	926
demonstrates that the per unit amount specified by the	927
manufacturer is less than the amount computed under division	928
(E)(1) of this section, the manufacturer shall make an aggregate	929
payment to the department in an amount equal to the difference	930
between the total amount of the per unit payments that were made	931
and the total amount that would have been paid by using the amount	932
computed under division (E)(1) of this section. The department	933
shall promptly notify the manufacturer of the amount owed, and the	934
manufacturer shall make an aggregate payment of the amount owed	935
not later than thirty days after receiving the department's	936
notice. Aggregate manufacturer payments received under this	937
section shall be deposited to the credit of the Ohio's best Rx	938
program fund created by section 5110.32 of the Revised Code.	939

(E)(1) For the purposes of division (B)(4)(a)(i)(D)(1)(a) of	940
this section, once each year the department shall compute the	941
weighted average of the per unit rebates for each drug using. In	942
making the computation, the department shall use the information	943
available to the department from submissions under division (A)(4)	944
of section 5110.25 of the Revised Code and the number of	945
individuals eligible for benefits under a state health benefit	946
plan or state retirement system health benefit plan. The	947
computation shall be made in accordance with section 5110.28 of	948
the Revised Code and rules adopted under section 5110.35 of the	949
Revised Code.	950

(2) If no computation can be made under division (C)(E)(1) of	951
this section, the rebatemanufacturer payment for the drug shall	952
be the amount specified under (B)(4)(a)(ii)division (D)(1)(b) of	953
this section.	954

(D)(F) The department shall seek written confirmation from	955
the centers for medicare and medicaid services that manufacturer	956
payments under this section are exempt from the medicaid best	957
price computation applicable under Title XIX of the "Social	958
Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396r-8, as amended.	959
The provisions of this section do not require a manufacturer to	960
make a manufacturer payment that would establish the	961
manufacturer's medicaid best price for a drug.	962

(G) On submission to the department by a manufacturer that	963
has entered into a rebatean agreement under this section of a	964
request the department considers reasonable, the department shall	965
permit the manufacturer to audit claims submitted under section	966
5110.16 of the Revised Code.	967

Sec. 5110.23. (A) The department of job and family services	968
shall compile both of the following:	969

(1) A list consisting of the name of each drug manufacturer	970
that enters into a rebatemanufacturer agreement under section	971
5110.21 of the Revised Code and the names of the drugs included in	972
each rebatemanufacturer agreement;	973

(2) A list consisting of the name of each participating	974
terminal distributor and the name of the drug mail order system	975
included in the Ohio's best Rx program pursuant to section 5110.11	976
of the Revised Code.	977

(B) The lists compiled under this section are public records	978
for the purpose of section 149.43 of the Revised Code. The	979
department shall specifically make the lists available to	980
physicians, participating terminal distributors, and other health	981
professionals.	982

Sec. 5110.26.  In submitting information about a drug under	983
section 5110.25 of the Revised Code, the department of	984
administrative services and each state retirement system shall do	985
all of the following:	986

(A) Compute and submit information separately forFor each of	987
the drug's national drug code numbers, compute individual	988
information or submit a formula that would permit the	989
determination of individual information;	990

(B) Submit the formula, per unit price, or formula and per	991
unit price information after each change to the formula or per	992
unit price, unless the formula or per unit price changes more than	993
once a week, in which case submit the formula or per unit price	994
information at least once each week;	995

(C) Provide for the formula or per unit price information to	996
reflect the formula or per unit price as most recently changed;	997

(D) Submit the information regarding the per unit rebate once	998
a year and provide for the information to reflect the per unit	999
rebate for the previous calendar year.	1000

Sec. 5110.27.  In accordance with section 5110.28 of the	1001
Revised Code and rules adopted under section 5110.35 of the	1002
Revised Code, the department of job and family services shall do	1003
all of the following for each drug included in the Ohio's best Rx	1004
program:	1005

(A) On receipt of each submission of formula or per unit	1006
price information under division (A)(3) of section 5110.25 of the	1007
Revised Code, or, at the department's discretion, more frequent	1008
intervals, the department shall do the following using the	1009
information available to the department from those submissions:	1010

(1) If the drug is covered by one or more state health	1011
benefit plans or state retirement system health benefit plans,	1012
compute the weighted average of the per unit prices under those	1013
plans;	1014

(2) If the drug is not covered by any state health benefit	1015
plan or state retirement system health benefit plan, compute a	1016
weighted average per unit price using the formula information	1017
received under division (A)(3) of section 5110.25 of the Revised	1018
Code for comparable drugs covered by one or more state health	1019
benefit plans or state retirement system health benefit plans;	1020

(3) Compute the weighted averages required by divisions	1021
(A)(1) and (2) of this section by using the number of individuals	1022
eligible for benefits under a state health benefit plan or state	1023
retirement system health benefit plan.	1024

(B) If the drug is covered byincluded in a rebate	1025
manufacturer agreement entered into under section 5110.21 of the	1026
Revised Code and the department has established a rebateprogram	1027
administration percentage by rule adopted under section 5110.35 of	1028
the Revised Code, at intervals specified by the department, the	1029
department shall do both of the following:	1030

(1) Multiply the amount agreed to under division	1031
(B)(4)(a)(D)(1) of section 5110.21 of the Revised Code by the	1032
rebateprogram administration percentage;	1033

(2) Subtract the product determined under division (B)(1) of	1034
this section from the amount agreed to under division	1035
(B)(4)(a)(D)(1) of section 5110.21 of the Revised Code.	1036

(C) If the drug is covered byincluded in a rebate	1037
manufacturer agreement entered into under section 5110.21 of the	1038
Revised Code, on receipt of each submission of formula or per unit	1039
price information under division (A)(3) of section 5110.25 of the	1040
Revised Code, or, at the department's discretion, more frequent	1041
intervals, the department shall subtract the amount agreed to	1042
under division (B)(4)(D)(1) of section 5110.21 of the Revised Code	1043
or the amount computed under division (B) of this section, as	1044
applicable, from the applicable amount computed under division	1045
(A)(1) or (2) of this section.	1046

Sec. 5110.29.  The department of job and family services	1047
shall report all of the following to each participating terminal	1048
distributor and the Ohio's best Rx program administratordrug mail	1049
order system included in the Ohio's best Rx program pursuant to	1050
section 5110.11 of the Revised Code in a manner enabling the	1051
distributor and administratorsystem to comply with section	1052
5110.14 of the Revised Code:	1053

(A) For each drug included in the Ohio's best Rx program that	1054
is not covered byincluded in a rebatemanufacturer agreement	1055
entered into under section 5110.21 of the Revised Code, the	1056
results of the department's computations under division (A) of	1057
section 5110.27 of the Revised Code.	1058

(B) For each drug included in the program that is covered by	1059
also included in a rebatemanufacturer agreement entered into	1060
under section 5110.21 of the Revised Code, the results of the	1061
department's computations under division (C) of section 5110.27 of	1062
the Revised Code.	1063

(C) The administrative fee, if any, determined by the	1064
department in accordance with rules adopted under section 5110.35	1065
of the Revised Code.	1066

Sec. 5110.32.  (A) The Ohio's best Rx program fund is hereby	1067
created. The fund shall be in the custody of the treasurer of	1068
state, but shall not be part of the state treasury. The fund shall	1069
consist of the following:	1070

(1) RebateManufacturer payments made by participating	1071
manufacturers made pursuant to agreements under section 5110.21 of	1072
the Revised Code, including any aggregate manufacturer payments	1073
made under division (D)(3)(c) of that section;	1074

(2) Administrative fees, if any administrative fee is	1075
determined by the department of job and family services in rules	1076
adopted under section 5110.35 of the Revised Code;	1077

(3) Any amounts donated to the fund and accepted by the	1078
department;	1079

(4) The fund's investment earnings.

1080

(B) The department of job and family services shall use money	1081
Money in the Ohio's best Rx program fund shall be used to make	1082
payments to participating terminal distributors and the Ohio's	1083
best Rx program administrator under section 5110.17 of the Revised	1084
Code.	1085

Sec. 5110.33.  (A) The Ohio's best Rx administration fund is	1086
hereby created in the state treasury. The treasurer of state shall	1087
transfer from the Ohio's best Rx program fund to the Ohio's best	1088
Rx administration fund amounts equal to the following:	1089

(1) Amounts resulting from application of the rebateprogram	1090
administration percentage, if a program administration percentage	1091
is determined by the department of job and family services in	1092
rules adopted under section 5110.3545110.35 of the Revised Code;	1093

(2) The amount of the administrative fees charged Ohio's best	1094
Rx participants, if an administrative fee is determined by the	1095
department of job and family services in rules adopted under	1096
section 5110.35 of the Revised Code;	1097

(3) The amount of any donations credited to the Ohio's best	1098
Rx program fund;	1099

(4) The amount of investment earnings credited to the Ohio's	1100
best Rx program fund.	1101

The treasurer of state shall make the transfers in accordance	1102
with a schedule developed by the treasurer of state and the	1103
department of job and family services.	1104

(B) The department of job and family services shall use money	1105
in the Ohio's best Rx administration fund to pay the	1106
administrative costs of the Ohio's best Rx program, including, but	1107
not limited to, costs associated with contracted services, staff,	1108
outreach activities, computers and network services, and the	1109
Ohio's best Rx program council.	1110

Sec. 5110.35.  The department of job and family services	1111
shall adopt rules in accordance with Chapter 119. of the Revised	1112
Code to implement the Ohio's best Rx program. The rules shall	1113
provide for all of the following:	1114

(A) Determination of family income for the purpose of	1115
division (A)(2)(a) of section 5110.05 of the Revised Code;	1116

(B) For the purpose of division (B) of section 5110.05	1117
5110.06 of the Revised Code, the application and annual	1118
reapplication process for the program, including the information	1119
and documentation to be submitted with applications and	1120
reapplications for the purpose of verifyingto verify eligibility	1121
and a process to be used in certifying that an applicant has	1122
attested to the accuracy of the information and documentation	1123
submitted with the application;	1124

(C) For the purpose of division (B) of section 5110.05 of the	1125
Revised Code and subject to section 5110.351 of the Revised Code,	1126
the application form for the program;	1127

(D) The method of providing information about the medicaid	1128
program to applicants under section 5110.07 of the Revised Code;	1129

(E)(D) For the purpose of section 5110.08 of the Revised	1130
Code, eligibility determination procedures;	1131

(E) Standards and procedures governing the drug mail order	1132
system included in the program pursuant to section 5110.11 of the	1133
Revised Code;	1134

(F) Subject to section 5110.352 of the Revised Code,	1135
periodically increasing the maximum professional fee that	1136
participating terminal distributors may charge Ohio's best Rx	1137
program participants pursuant to an agreement entered into under	1138
section 5110.12 of the Revised Code or the Ohio's best Rx program	1139
administrator may charge under a contract entered into under	1140
section 5110.10 of the Revised Code;	1141

(G) Subject to section 5110.353 of the Revised Code, the	1142
amount of the administrative fee, if any, participating terminal	1143
distributors are to chargethat Ohio's best Rx program	1144
participants under section 5110.12 of the Revised Code or the	1145
Ohio's best Rx program administrator may charge under a contract	1146
entered into under section 5110.10 of the Revised Codeare to be	1147
charged under the program;	1148

(H) The electronic method for participating terminal	1149
distributors and the Ohio's best Rx program administrator to	1150
submitsubmission of claims to the department under section	1151
5110.16 of the Revised Code;	1152

(I) Additional information participating terminal	1153
distributors and the Ohio's best Rx program administrator shall	1154
includeto be included on claims submitted under section 5110.16	1155
of the Revised Code that the department determines is necessary	1156
for the department to be able to make payments under section	1157
5110.17 of the Revised Code;	1158

(J) The method for making payments to participating terminal	1159
distributors or the Ohio's best Rx program administrator under	1160
section 5110.17 of the Revised Code;	1161

(K) Subject to section 5110.354 of the Revised Code, the	1162
percentage, if any, that is the rebateprogram administration	1163
percentage;	1164

(L) If the department determines it is best that	1165
participating manufacturers make rebatespayments under section	1166
5110.21 of the Revised Code on a basis other than quarterly, a	1167
schedule for payment of the rebatesmaking the payments;	1168

(M) The process for the department of administrative services	1169
and state retirement systems to calculate and submit the	1170
information required by section 5110.25 of the Revised Code;	1171

(N) Procedures for making computations under sections 5110.21	1172
and 5110.27 of the Revised Code;	1173

(O) Standards and procedures for the use and preservation of	1174
records regarding the Ohio's best Rx program by the department and	1175
the Ohio's best Rx program administrator pursuant to section	1176
5110.59 of the Revised Code;	1177

(P) For the purpose of section 5110.10 of the Revised Code,	1178
the standards and procedures governing the operation of the mail	1179
order system by the Ohio's best Rx program administrator;	1180

(Q) The efficient administration of other provisions of this	1181
chapter for which the department determines rules are necessary.	1182

Sec. 5110.352.  As used in this section, "medicaid dispensing	1183
fee" means the dispensing fee established under section 5111.071	1184
of the Revised Code for the medicaid program.	1185

In adopting a rule under division (F) of section 5110.35 of	1186
the Revised Code increasing the maximum amount of the professional	1187
fee participating terminal distributors may charge Ohio's best Rx	1188
program participants pursuant to an agreement entered into under	1189
section 5110.12 of the Revised Code and the Ohio's best Rx program	1190
administrator may charge under a contract entered into under	1191
section 5110.10 of the Revised Code, the department of job and	1192
family services shall review the amount of the professional fee	1193
once a year or, at the department's discretion, at more frequent	1194
intervals and. The department shall not increase the professional	1195
fee to an amount exceeding the medicaid dispensing fee.	1196

A participating terminal distributor and the Ohio's best Rx	1197
program administrator may charge a maximum three dollar	1198
professional fee regardless of whether the medicaid dispensing fee	1199
for that drug is less than that amount. The department, however,	1200
may not adopt a rule increasing the maximum professional fee for	1201
that drug until the medicaid dispensing fee for that drug exceeds	1202
that amount.	1203

Sec. 5110.353. (A) Once a year or, at the discretion of the	1204
department of job and family services, at more frequent intervals,	1205
the department shall determine the amount, if any, to be specified	1206
in a rule adopted under division (G) of section 5110.35 of the	1207
Revised Code as the administrative fee. In determining the amount	1208
of the administrative fee, the department shall determine an	1209
amount, not exceedingthat each Ohio's best Rx program participant	1210
will be charged as an administrative fee to be used in paying the	1211
administrative costs of the program. The fee, which shall not	1212
exceed one dollar per transaction, shall be specified in rules	1213
adopted under section 5110.35 of the Revised Code. In adopting the	1214
rules, the department shall specify a fee that results in an	1215
amount that equals or is less than the amount needed to cover the	1216
administrative costs of the Ohio's best Rx program when added to	1217
the sum of the following:	1218

(1) The amount resulting from the application of the rebate	1219
program administration percentage, if the department determines a	1220
program administration percentage in rules adopted under section	1221
5110.35 of the Revised Code;	1222

(2) The investment earnings of the Ohio's best Rx program	1223
fund created by section 5110.32 of the Revised Code;	1224

(3) Any amounts accepted by the department as donations to	1225
the Ohio's best Rx program fund created by section 5110.32 of the	1226
Revised Code.	1227

(B) Once a year or, at the discretion of the department, at	1228
more frequent intervals, the department shall report the	1229
methodology underlying the determination of the administrative fee	1230
to the Ohio's best Rx program council.	1231

Sec. 5110.354. (A) At least once a year or, at the discretion	1232
of the department of job and family services, at more frequent	1233
intervals, the department shall determine the percentage, if any,	1234
to be specified in a rule adopted under division (K) of section	1235
5110.35 of the Revised Code as the rebate administration	1236
percentageof each manufacturer payment made under an agreement	1237
entered into under section 5110.21 of the Revised Code that will	1238
be used in paying the administrative costs of the Ohio's best Rx	1239
program. The percentage, which shall not exceed five per cent,	1240
shall resultbe specified in rules adopted under section 5110.35	1241
of the Revised Code. In adopting the rules, the department shall	1242
specify a percentage that results in an amount that equals or is	1243
less than the amount needed to cover the administrative costs of	1244
the Ohio's best Rx program when added to the sum of the following:	1245

(1) The amount resulting from administrative fee specified in	1246
fees, if the department determines an administrative fee in rules	1247
adopted under section 5110.3535110.35 of the Revised Code;	1248

(2) The investment earnings of the Ohio's best Rx program	1249
fund created by section 5110.32 of the Revised Code;	1250

(3) Any amounts accepted by the department as donations to	1251
the Ohio's best Rx program fund created by section 5110.32 of the	1252
Revised Code.	1253

(B) Once a year or, at the discretion of the department, at	1254
more frequent intervals, the department shall report the	1255
methodology underlying the determination of the rebateprogram	1256
administration percentage to the Ohio's best Rx program council.	1257

Sec. 5110.39.  Not later than the first day of March of each	1258
year, the department of job and family services shall do all of	1259
the following:	1260

(A) Create a list of the twenty-five drugs most often	1261
dispensed to Ohio's best Rx program participants under the	1262
program, using data from the most recent six-month period for	1263
which the data is available;	1264

(B) Determine the average amount that participating terminal	1265
distributors chargeparticipants are charged under the program, on	1266
a date selected by the department, participants for each drug	1267
included on the list created under division (A) of this section;	1268

(C) Determine, for the date selected for division (B) of this	1269
section, the average usual and customary charge of participating	1270
terminal distributors for each drug included on the list created	1271
under division (A) of this section;	1272

(D) By comparing the average charges determined under	1273
divisions (B) and (C) of this section, determine the average	1274
percentage savings in the amount participating terminal	1275
distributors charge Ohio's best Rx program participants receive	1276
for each drug included on the list created under division (A) of	1277
this section.	1278

Sec. 5110.55.  Information transmitted by or to any of the	1279
following for any purpose related to the Ohio's best Rx program is	1280
confidential to the extent required by federal and state law:	1281

(A) Drug manufacturers;

1282

(B) Terminal distributors of dangerous drugs;

1283

(C) The Ohio's best Rx program administrator;

1284

(D) The department of job and family services and any person	1285
under contract with the department pursuant to division (B) of	1286
section 5110.02 of the Revised Code to serve as the program's	1287
administrator;	1288

(E)(D) The department of administrative services;

1289

(F)(E) The state retirement systems;

1290

(G)(F) A state health benefit plan or state retirement system	1291
health benefit plan;	1292

(H)(G) Ohio's best Rx program participants;

1293

(I)(H) Any other government entity or person.

1294

Sec. 5110.56.  (A) Except as provided by section 5110.57 of	1295
the Revised Code, all of the following are trade secrets, are not	1296
public records for the purposes of section 149.43 of the Revised	1297
Code, and shall not be used, released, published, or disclosed in	1298
a form that reveals a specific drug or the identity of a drug	1299
manufacturer:	1300

(1) The amounts determined under section 5110.17 of the	1301
Revised Code;	1302

(2) Information disclosed in a rebatemanufacturer agreement	1303
entered into under section 5110.21 of the Revised Code or in	1304
communications related to a rebatean agreement;	1305

(3) Information that the department of administrative	1306
services and state retirement systems submit to the department of	1307
job and family services under divisions (A)(3) and (4) of section	1308
5110.25 of the Revised Code;	1309

(4) The elements of the computations under division (C)(E) of	1310
section 5110.21 of the Revised Code and under section 5110.27 of	1311
the Revised Code and any results of those computations that reveal	1312
or could be used to reveal the drug pricing, manufacturer payment,	1313
or rebate information and amounts used to make the computations.	1314

(B) No person or government entity shall use or reveal any	1315
information specified in division (A) of this section except as	1316
required for the implementation of this chapter.	1317

Sec. 5110.57.  Sections 5110.55 and 5110.56 of the Revised	1318
Code shall not preclude the department of job and family services	1319
from disclosing information necessary for the implementation of	1320
this chapter, including the Ohio's best Rx program price to	1321
participating terminal distributors or the Ohio's best Rx program	1322
administratorwhen it is disclosed under section 5110.29 of the	1323
Revised Code to participating terminal distributors or the drug	1324
mail order system included in the Ohio's best Rx program pursuant	1325
to section 5110.11 of the Revised Code.	1326

Sec. 5110.58. (A) As used in this section, "identifying	1327
information" means information that identifies or could be used to	1328
identify an Ohio's best Rx program applicant or participant.	1329
"Identifying information" does not include aggregate information	1330
about applicants and participants that does not identify and could	1331
not be used to identify an individual applicant or participant.	1332

(B) Except as provided in divisions (C), (D), and (E) of this	1333
section, no person or government entity shall sell, solicit,	1334
disclose, receive, or use identifying information or knowingly	1335
permit the use of identifying information.	1336

(C)(1) The department of job and family services and the	1337
Ohio's best Rx program administrator may solicit, disclose,	1338
receive, or use identifying information or knowingly permit the	1339
use of identifying information for a purpose directly connected to	1340
the administration of the Ohio's best Rx program, including	1341
disclosing and knowingly permitting the use of identifying	1342
information included in a claim that a participating manufacturer	1343
audits pursuant to division (D)(G) of section 5110.21 of the	1344
Revised Code, contacting Ohio's best Rx program applicants or	1345
participants regarding participation in the program, and notifying	1346
applicants and participants regarding participating terminal	1347
distributors and the drug mail order system included in the	1348
program pursuant to section 5110.11 of the Revised Code.	1349

(2) The department and administrator may solicit, disclose,	1350
receive, or use identifying information or knowingly permit the	1351
use of identifying information to the extent required by federal	1352
law.	1353

(3) The department and administrator may disclose identifying	1354
information to the Ohio's best Rx program applicant or participant	1355
who is the subject of that information or to the parent, spouse,	1356
guardian, or custodian of that applicant or participant.	1357

(D)(1) A participating terminal distributor or the Ohio's	1358
best Rx program administrator may solicit, disclose, receive, or	1359
use identifying information or knowingly permit the use of	1360
identifying information to the extent required or permitted by an	1361
agreement the distributor enters into under section 5110.12 of the	1362
Revised Code or a contract the administrator enters into under	1363
section 5110.10 of the Revised Code.	1364

(2) The drug mail order system included in the program	1365
pursuant to section 5110.11 of the Revised Code may solicit,	1366
disclose, receive, or use identifying information or knowingly	1367
permit the use of identifying information to the extent required	1368
or permitted by the department.	1369

(E) A participating manufacturer may, for the purpose of	1370
auditing a claim pursuant to division (D)(G) of section 5110.21 of	1371
the Revised Code, solicit, receive, and use identifying	1372
information included in the claim.	1373

Sec. 5110.59. The department of job and family services and	1374
the Ohio's best Rx program administrator shall use and preserve	1375
records regarding the Ohio's best Rx program in accordance with	1376
rules adopted under section 5110.35 of the Revised Code. This	1377
section applies to the department's or administrator's use and	1378
preservation ofThe department shall use and preserve the records	1379
in accordance with those rules, regardless of whether the	1380
department generated the records or received or generated by the	1381
department, any otherthem from another government entity, or any	1382
person.	1383

Section 2. That existing sections 127.16, 2921.13, 5110.01,	1384
5110.02, 5110.03, 5110.05, 5110.08, 5110.09, 5110.12, 5110.13,	1385
5110.14, 5110.15, 5110.16, 5110.17, 5110.18, 5110.19, 5110.21,	1386
5110.23, 5110.26, 5110.27, 5110.29, 5110.32, 5110.33, 5110.35,	1387
5110.352, 5110.353, 5110.354, 5110.39, 5110.55, 5110.56, 5110.57,	1388
5110.58, and 5110.59 and sections 5110.10, 5110.11, 5110.22,	1389
5110.28, and 5110.351 of the Revised Code are hereby repealed.	1390

Section 3. Divisions (D)(3)(b) and (c) of section 5110.21 of	1391
the Revised Code, as amended by this act, apply only with respect	1392
to agreements that are entered into under that section on and	1393
after the effective date of this act.	1394