To amend section 1739.05 and to enact sections 1751.68, 1751.69, 3923.84, and 3923.85, of the Revised Code regarding health insurance coverage for orally administered cancer medications and the procedures insured persons are required or permitted to use in acquiring certain non-self-injectable and compounded medications.

Section 1. That section 1739.05 be amended and sections 1751.68, 1751.69, 3923.84, and 3923.85 of the Revised Code be enacted to read as follows:

Sec. 1739.05.  (A) A multiple employer welfare arrangement that is created pursuant to sections 1739.01 to 1739.22 of the Revised Code and that operates a group self-insurance program may be established only if any of the following applies:

(1) The arrangement has and maintains a minimum enrollment of three hundred employees of two or more employers.

(2) The arrangement has and maintains a minimum enrollment of three hundred self-employed individuals.

(3) The arrangement has and maintains a minimum enrollment of three hundred employees or self-employed individuals in any combination of divisions (A)(1) and (2) of this section.

(B) A multiple employer welfare arrangement that is created pursuant to sections 1739.01 to 1739.22 of the Revised Code and that operates a group self-insurance program shall comply with all laws applicable to self-funded programs in this state, including sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.80, 3923.84, 3923.85, 3924.031, 3924.032, and 3924.27 of the Revised Code.

(C) A multiple employer welfare arrangement created pursuant to sections 1739.01 to 1739.22 of the Revised Code shall solicit enrollments only through agents or solicitors licensed pursuant to Chapter 3905. of the Revised Code to sell or solicit sickness and accident insurance.

(D) A multiple employer welfare arrangement created pursuant to sections 1739.01 to 1739.22 of the Revised Code shall provide benefits only to individuals who are members, employees of members, or the dependents of members or employees, or are eligible for continuation of coverage under section 1751.53 or 3923.38 of the Revised Code or under Title X of the "Consolidated Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 U.S.C.A. 1161, as amended.

Sec. 1751.68.  (A) Notwithstanding section 3901.71 of the Revised Code and subject to division (B) of this section, no individual or group health insuring corporation policy, contract, or agreement providing basic health care services or prescription drug services that is delivered, issued for delivery, or renewed in this state on or after the effective date of this section and that provides coverage for cancer chemotherapy treatment shall provide coverage for a prescribed, orally administered cancer medication on a less favorable basis than coverage for intravenously administered or injected cancer medications.

(B) The prohibition in division (A) of this section includes a prohibition on imposing a coverage limit, copayment, or deductible that is greater, or a prior authorization requirement that is more stringent, than any coverage limit, copayment, deductible, or prior authorization requirement in the policy, contract, or agreement that applies to coverage for intravenously administered or injected cancer medications.

Sec. 1751.69.  (A) As used in this section:

(1) "Dangerous drug" and "pharmacy" have the same meanings as in section 4729.01 of the Revised Code.

(2) "Non-self-injectable medication" means a dangerous drug intended for administration by injection that an individual cannot reasonably self-administer.

(3) "Retail seller" has the same meaning as in section 4729.01 of the Revised Code, and includes a specialty pharmacy or mail order pharmacy.

(B) No individual or group health insuring corporation policy, contract, or agreement providing basic health care services or prescription drug services that is delivered, issued for delivery, or renewed in this state on or after the effective date of this section and that provides coverage for non-self-injectable medications, medications that must be compounded immediately prior to administration, or both, shall do either of the following:

(1) Require an enrollee to take possession of such a medication from a pharmacy that is a retail seller;

(2) Give an enrollee the option of having such a medication delivered directly to the enrollee by mail or any means of commercial shipment.

Sec. 3923.84.  (A) Notwithstanding section 3901.71 of the Revised Code and subject to division (B) of this section, neither of the following that provides coverage for cancer chemotherapy treatment shall provide coverage for a prescribed, orally administered cancer medication on a less favorable basis than for intravenously administered or injected cancer medications:

(1) An individual or group policy of sickness and accident insurance that is delivered, issued for delivery, or renewed in this state on or after the effective date of this section;

(2) A public employee benefit plan that is established or modified in this state on or after the effective date of this section.

(B) The prohibition in division (A) of this section includes a prohibition on imposing a coverage limit, copayment, or deductible that is greater, or a prior authorization requirement that is more stringent, than any coverage limit, copayment, deductible, or prior authorization requirement in the policy or plan that applies to coverage for intravenously administered or injected cancer medications.

Sec. 3923.85.  (A) As used in this section:

(1) "Dangerous drug" and "pharmacy" have the same meanings as in section 4729.01 of the Revised Code.

(2) "Non-self-injectable medication" means a dangerous drug intended for administration by injection that an individual cannot reasonably self-administer.

(3) "Retail seller" has the same meaning as in section 4729.01 of the Revised Code, and includes a specialty pharmacy or mail order pharmacy.

(B) Neither of the following that provides coverage for non-self-injectable medications, medications that must be compounded immediately prior to administration, or both, shall require an insured to take possession of such a medication from a pharmacy that is a retail seller or give an insured the option of having such a medication delivered directly to the insured by mail or any means of commercial shipment:

(1) An individual or group policy of sickness and accident insurance that is delivered, issued for delivery, or renewed in this state on or after the effective date of this section;

(2) A public employee benefit plan that is established or modified in this state on or after the effective date of this section.

Section 2.  That existing section 1739.05 of the Revised Code is hereby repealed.