Doctors, medical groups back bill to bar midyear formulary changes

Chair Wilson presided over testimony and a second hearing on Senate Bill 160, which backers say would prevent commercial health plans from changing drug formularies midyear and disrupt patients’ treatments. "This bill is pretty simple. It essentially prohibits a health plan from changing their drug formulary during a calendar year," Monica Hickel, vice president of advocacy for the Ohio State Medical Association, told the Financial Institutions, Insurance, and Technology Committee.

Hickel said the measure targets commercial plans only and includes guardrails: plans could switch a patient to a newly available generic and could remove a drug if its cost rises "more than 5% plus inflation during the calendar year." She said those limits respond to concerns raised in prior legislative sessions and that the bill seeks to give stability to "a million plus Ohioans" who choose plans based on drug coverage.

A practicing rheumatologist, Dr. Stephanie Ott described patient cases she said illustrate the stakes when coverage changes in the middle of a plan year. "The fact that you can no longer get your medication is not a qualifying event," Ott said, arguing that life‑changing diagnoses such as a new autoimmune disease should allow patients to keep needed medicines. She recounted patients who lost control of chronic disease, missed school or work, or required emergency care after formularies shifted.

Proponents said Medicaid is not included because Medicaid maintains a single preferred drug list that changes only once per year; they acknowledged the bill cannot affect Medicare or ERISA plans. The committee was given five written testimonies and heard no formal amendment or vote at the hearing. Chair Wilson closed the second hearing on Senate Bill 160 and invited members to review the written submissions.