Ohio senators hold first hearing on bill to ban midyear nonmedical prescription switches

Senator Liston, sponsor of Senate Bill 160, told the Senate Financial Institutions, Insurance, and Technology Committee that the bill would "prohibit the practice of non medical switching in the middle of a plan year." The measure would stop insurers from changing drug coverage during a contract period for reasons unrelated to a patient’s health, she said.

The bill’s backers and several physician-testifying senators said nonmedical switching — when an insurer replaces a covered medication with a different drug chosen for cost savings — can destabilize chronic conditions and increase downstream health care costs. "When people are forced to change treatment for no reason, previously controlled chronic conditions often destabilize," Liston said, citing conditions from depression to Crohn’s disease.

The bill includes specific exceptions. "This bill does not prohibit an insurer from changing to a generic form of a drug should [one] become available during the plan year," Liston said, and it also allows changes if a medication’s price "increases by more than 5% over the rate of inflation." Committee members discussed how those carve-outs aim to balance patient stability with insurers’ need to respond to major price shifts.

Committee members pressed sponsors on the scope and enforcement of the proposal. Vice Chair Lang noted the bill "will only affect about 10 percent of Ohioans," referring to people in market plans not governed by federal rules, and asked how common the practice is. Sponsors said the practice is more frequent among therapies that are new or costly, such as biologic treatments and some insulins, and that Medicaid’s move to a single formulary had reduced similar midyear changes in that program.

Members also asked whether the bill creates notice requirements or penalties. Sponsors said the draft contains no specific patient-notification language and no new penalty provisions; enforcement would remain under the state Department of Insurance. "It would remain regulated, under the Department of Insurance," one sponsor said. Committee members discussed that clearer notice and enforcement mechanisms could be considered in future drafts.

Senator Patton and others offered practical examples from patients who paid out of pocket to keep a particular brand. Sponsors responded the bill aims to preserve the contract a consumer chooses during open enrollment so patients receive the coverage they expected for the year. The committee held a first hearing and did not vote on the bill at the session.

The chair closed the first hearing on Senate Bill 160 and proceeded to other agenda items.