130th Ohio General Assembly
The online versions of legislation provided on this website are not official. Enrolled bills are the final version passed by the Ohio General Assembly and presented to the Governor for signature. The official version of acts signed by the Governor are available from the Secretary of State's Office in the Continental Plaza, 180 East Broad St., Columbus.

Sub. S. B. No. 251  As Passed by the Senate
As Passed by the Senate

126th General Assembly
Regular Session
2005-2006
Sub. S. B. No. 251


Senators Spada, Hagan, Armbruster, Dann, Fedor, Goodman, Harris, Kearney, Miller, D., Mumper, Padgett, Roberts, Zurz, Niehaus, Gardner 



A BILL
To amend sections 127.16, 2921.13, 5110.01, 5110.02, 5110.05, 5110.08, 5110.09, 5110.12, 5110.13, 5110.16, 5110.17, 5110.18, 5110.19, 5110.21, 5110.23, 5110.29, 5110.32, 5110.33, 5110.35, 5110.352, 5110.353, 5110.354, 5110.38, 5110.39, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59; to amend, for the purpose of adopting new section numbers as indicated in parentheses, sections 5110.05 (5110.14), 5110.07 (5110.16), 5110.08 (5110.17), 5110.09 (5110.18), 5110.12 (5110.20), 5110.13 (5110.21), 5110.16 (5110.22), 5110.17 (5110.23), 5110.18 (5110.24), 5110.19 (5110.25), 5110.21 (5110.27), 5110.23 (5110.54), 5110.29 (5110.11), 5110.32 (5110.42), 5110.33 (5110.43), and 5110.39 (5110.13); to enact new sections 5110.03, 5110.05, 5110.07, 5110.08, 5110.09, 5110.10, 5110.12, 5110.15, 5110.19, 5110.26, 5110.28, 5110.29, 5110.32, and 5110.39 and sections 5110.021, 5110.04, 5110.30, and 5110.31; and to repeal sections 5110.03, 5110.10, 5110.11, 5110.14, 5110.15, 5110.22, 5110.25, 5110.26, 5110.27, 5110.28, and 5110.351 of the Revised Code to modify the Ohio's Best Rx Program; and to amend sections 127.16, 173.06, 173.062, 173.99, 2921.13, 5110.01, 5110.02, 5110.021, 5110.03, 5110.04, 5110.05, 5110.07, 5110.08, 5110.09, 5110.10, 5110.11, 5110.12, 5110.13, 5110.14, 5110.15, 5110.16, 5110.17, 5110.18, 5110.19, 5110.20, 5110.21, 5110.22, 5110.23, 5110.24, 5110.25, 5110.26, 5110.27, 5110.28, 5110.29, 5110.30, 5110.31, 5110.32, 5110.35, 5110.352, 5110.353, 5110.354, 5110.36, 5110.37, 5110.38, 5110.39, 5110.40, 5110.42, 5110.43, 5110.45, 5110.47, 5110.54, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59; to amend, for the purpose of adopting new section numbers as indicated in parentheses, sections 173.062 (173.061), 5110.01 (173.71), 5110.02 (173.72), 5110.021 (173.721), 5110.03 (173.73), 5110.04 (173.731), 5110.05 (173.732), 5110.07 (173.74), 5110.08 (173.741), 5110.09 (173.742), 5110.10 (173.75), 5110.11 (173.751), 5110.12 (173.752), 5110.13 (173.753), 5110.14 (173.76), 5110.15 (173.77), 5110.16 (173.771), 5110.17 (173.772), 5110.18 (173.773), 5110.19 (173.78), 5110.20 (173.79), 5110.21 (173.791), 5110.22 (173.80), 5110.23 (173.801), 5110.24 (173.802), 5110.25 (173.803), 5110.26 (173.81), 5110.27 (173.811), 5110.28 (173.812), 5110.29 (173.813), 5110.30 (173.814), 5110.31 (173.815), 5110.32 (173.82), 5110.35 (173.83), 5110.352 (173.831), 5110.353 (173.832), 5110.354 (173.833), 5110.36 (173.84), 5110.37 (173.722), 5110.38 (173.724), 5110.39 (173.861), 5110.40 (173.723), 5110.42 (173.85), 5110.43 (173.86), 5110.45 (173.87), 5110.46 (173.871), 5110.47 (173.872), 5110.48 (173.873), 5110.49 (173.874), 5110.50 (173.875), 5110.51 (173.876), 5110.54 (173.88), 5110.55 (173.89), 5110.56 (173.891), 5110.57 (173.892), 5110.58 (173.90), and 5110.59 (173.91); and to repeal sections 173.061, 173.07, 173.071, 173.072, and 5110.99 of the Revised Code on July 1, 2007, to eliminate the prescription drug component of the Golden Buckeye Card Program and to transfer the Ohio's Best Rx Program to the Department of Aging.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 127.16, 2921.13, 5110.01, 5110.02, 5110.05, 5110.08, 5110.09, 5110.12, 5110.13, 5110.16, 5110.17, 5110.18, 5110.19, 5110.21, 5110.23, 5110.29, 5110.32, 5110.33, 5110.35, 5110.352, 5110.353, 5110.354, 5110.38, 5110.39, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59 be amended; sections 5110.05 (5110.14), 5110.07 (5110.16), 5110.08 (5110.17), 5110.09 (5110.18), 5110.12 (5110.20), 5110.13 (5110.21), 5110.16 (5110.22), 5110.17 (5110.23), 5110.18 (5110.24), 5110.19 (5110.25), 5110.21 (5110.27), 5110.23 (5110.54), 5110.29 (5110.11), 5110.32 (5110.42), 5110.33 (5110.43), and 5110.39 (5110.13) be amended for the purpose of adopting new sections numbers as indicated in parentheses; and new sections 5110.03, 5110.05, 5110.07, 5110.08, 5110.09, 5110.10, 5110.12, 5110.15, 5110.19, 5110.26, 5110.28, 5110.29, 5110.32, and 5110.39 and sections 5110.021, 5110.04, 5110.30, and 5110.31 of the Revised Code be enacted to read as follows:
Sec. 127.16.  (A) Upon the request of either a state agency or the director of budget and management and after the controlling board determines that an emergency or a sufficient economic reason exists, the controlling board may approve the making of a purchase without competitive selection as provided in division (B) of this section.
(B) Except as otherwise provided in this section, no state agency, using money that has been appropriated to it directly, shall:
(1) Make any purchase from a particular supplier, that would amount to fifty thousand dollars or more when combined with both the amount of all disbursements to the supplier during the fiscal year for purchases made by the agency and the amount of all outstanding encumbrances for purchases made by the agency from the supplier, unless the purchase is made by competitive selection or with the approval of the controlling board;
(2) Lease real estate from a particular supplier, if the lease would amount to seventy-five thousand dollars or more when combined with both the amount of all disbursements to the supplier during the fiscal year for real estate leases made by the agency and the amount of all outstanding encumbrances for real estate leases made by the agency from the supplier, unless the lease is made by competitive selection or with the approval of the controlling board.
(C) Any person who authorizes a purchase in violation of division (B) of this section shall be liable to the state for any state funds spent on the purchase, and the attorney general shall collect the amount from the person.
(D) Nothing in division (B) of this section shall be construed as:
(1) A limitation upon the authority of the director of transportation as granted in sections 5501.17, 5517.02, and 5525.14 of the Revised Code;
(2) Applying to medicaid provider agreements under Chapter 5111. of the Revised Code or payments or provider agreements under the disability medical assistance program established under Chapter 5115. of the Revised Code;
(3) Applying to the purchase of examinations from a sole supplier by a state licensing board under Title XLVII of the Revised Code;
(4) Applying to entertainment contracts for the Ohio state fair entered into by the Ohio expositions commission, provided that the controlling board has given its approval to the commission to enter into such contracts and has approved a total budget amount for such contracts as agreed upon by commission action, and that the commission causes to be kept itemized records of the amounts of money spent under each contract and annually files those records with the clerk of the house of representatives and the clerk of the senate following the close of the fair;
(5) Limiting the authority of the chief of the division of mineral resources management to contract for reclamation work with an operator mining adjacent land as provided in section 1513.27 of the Revised Code;
(6) Applying to investment transactions and procedures of any state agency, except that the agency shall file with the board the name of any person with whom the agency contracts to make, broker, service, or otherwise manage its investments, as well as the commission, rate, or schedule of charges of such person with respect to any investment transactions to be undertaken on behalf of the agency. The filing shall be in a form and at such times as the board considers appropriate.
(7) Applying to purchases made with money for the per cent for arts program established by section 3379.10 of the Revised Code;
(8) Applying to purchases made by the rehabilitation services commission of services, or supplies, that are provided to persons with disabilities, or to purchases made by the commission in connection with the eligibility determinations it makes for applicants of programs administered by the social security administration;
(9) Applying to payments by the department of job and family services under section 5111.13 of the Revised Code for group health plan premiums, deductibles, coinsurance, and other cost-sharing expenses;
(10) Applying to any agency of the legislative branch of the state government;
(11) Applying to agreements or contracts entered into under section 5101.11, 5101.20, 5101.201, 5101.21, or 5101.214 of the Revised Code;
(12) Applying to purchases of services by the adult parole authority under section 2967.14 of the Revised Code or by the department of youth services under section 5139.08 of the Revised Code;
(13) Applying to dues or fees paid for membership in an organization or association;
(14) Applying to purchases of utility services pursuant to section 9.30 of the Revised Code;
(15) Applying to purchases made in accordance with rules adopted by the department of administrative services of motor vehicle, aviation, or watercraft fuel, or emergency repairs of such vehicles;
(16) Applying to purchases of tickets for passenger air transportation;
(17) Applying to purchases necessary to provide public notifications required by law or to provide notifications of job openings;
(18) Applying to the judicial branch of state government;
(19) Applying to purchases of liquor for resale by the division of liquor control;
(20) Applying to purchases of motor courier and freight services made in accordance with department of administrative services rules;
(21) Applying to purchases from the United States postal service and purchases of stamps and postal meter replenishment from vendors at rates established by the United States postal service;
(22) Applying to purchases of books, periodicals, pamphlets, newspapers, maintenance subscriptions, and other published materials;
(23) Applying to purchases from other state agencies, including state-assisted institutions of higher education;
(24) Limiting the authority of the director of environmental protection to enter into contracts under division (D) of section 3745.14 of the Revised Code to conduct compliance reviews, as defined in division (A) of that section;
(25) Applying to purchases from a qualified nonprofit agency pursuant to sections 125.60 to 125.6012 or 4115.31 to 4115.35 of the Revised Code;
(26) Applying to payments by the department of job and family services to the United States department of health and human services for printing and mailing notices pertaining to the tax refund offset program of the internal revenue service of the United States department of the treasury;
(27) Applying to contracts entered into by the department of mental retardation and developmental disabilities under sections 5123.18, 5123.182, and 5123.199 of the Revised Code;
(28) Applying to payments made by the department of mental health under a physician recruitment program authorized by section 5119.101 of the Revised Code;
(29) Applying to contracts entered into with persons by the director of commerce for unclaimed funds collection and remittance efforts as provided in division (F) of section 169.03 of the Revised Code. The director shall keep an itemized accounting of unclaimed funds collected by those persons and amounts paid to them for their services.
(30) Applying to purchases made by a state institution of higher education in accordance with the terms of a contract between the vendor and an inter-university purchasing group comprised of purchasing officers of state institutions of higher education;
(31) Applying to the department of job and family services' purchases of health assistance services under the children's health insurance program part I provided for under section 5101.50 of the Revised Code or the children's health insurance program part II provided for under section 5101.51 of the Revised Code;
(32) Applying to payments by the attorney general from the reparations fund to hospitals and other emergency medical facilities for performing medical examinations to collect physical evidence pursuant to section 2907.28 of the Revised Code;
(33) Applying to contracts with a contracting authority or administrative receiver under division (B) of section 5126.056 of the Revised Code;
(34) Applying to reimbursements paid to the United States department of veterans affairs for pharmaceutical and patient supply purchases made on behalf of the Ohio veterans' home agency;
(35) Applying to agreements the department of job and family services enters entered into with terminal distributors of dangerous drugs under section 5110.12 5110.20 of the Revised Code.
(E) Notwithstanding division (B)(1) of this section, the cumulative purchase threshold shall be seventy-five thousand dollars for the departments of mental retardation and developmental disabilities, mental health, rehabilitation and correction, and youth services.
(F) When determining whether a state agency has reached the cumulative purchase thresholds established in divisions (B)(1), (B)(2), and (E) of this section, all of the following purchases by such agency shall not be considered:
(1) Purchases made through competitive selection or with controlling board approval;
(2) Purchases listed in division (D) of this section;
(3) For the purposes of the thresholds of divisions (B)(1) and (E) of this section only, leases of real estate.
(G) As used in this section, "competitive selection," "purchase," "supplies," and "services" have the same meanings as in section 125.01 of the Revised Code.
Sec. 2921.13.  (A) No person shall knowingly make a false statement, or knowingly swear or affirm the truth of a false statement previously made, when any of the following applies:
(1) The statement is made in any official proceeding.
(2) The statement is made with purpose to incriminate another.
(3) The statement is made with purpose to mislead a public official in performing the public official's official function.
(4) The statement is made with purpose to secure the payment of unemployment compensation; Ohio works first; prevention, retention, and contingency benefits and services; disability financial assistance; retirement benefits; economic development assistance, as defined in section 9.66 of the Revised Code; or other benefits administered by a governmental agency or paid out of a public treasury.
(5) The statement is made with purpose to secure the issuance by a governmental agency of a license, permit, authorization, certificate, registration, release, or provider agreement.
(6) The statement is sworn or affirmed before a notary public or another person empowered to administer oaths.
(7) The statement is in writing on or in connection with a report or return that is required or authorized by law.
(8) The statement is in writing and is made with purpose to induce another to extend credit to or employ the offender, to confer any degree, diploma, certificate of attainment, award of excellence, or honor on the offender, or to extend to or bestow upon the offender any other valuable benefit or distinction, when the person to whom the statement is directed relies upon it to that person's detriment.
(9) The statement is made with purpose to commit or facilitate the commission of a theft offense.
(10) The statement is knowingly made to a probate court in connection with any action, proceeding, or other matter within its jurisdiction, either orally or in a written document, including, but not limited to, an application, petition, complaint, or other pleading, or an inventory, account, or report.
(11) The statement is made on an account, form, record, stamp, label, or other writing that is required by law.
(12) The statement is made in connection with the purchase of a firearm, as defined in section 2923.11 of the Revised Code, and in conjunction with the furnishing to the seller of the firearm of a fictitious or altered driver's or commercial driver's license or permit, a fictitious or altered identification card, or any other document that contains false information about the purchaser's identity.
(13) The statement is made in a document or instrument of writing that purports to be a judgment, lien, or claim of indebtedness and is filed or recorded with the secretary of state, a county recorder, or the clerk of a court of record.
(14) The statement is made with purpose to obtain an Ohio's best Rx program enrollment card under section 5110.09 5110.18 of the Revised Code or a payment from the department of job and family services under section 5110.17 5110.23 of the Revised Code.
(15) The statement is made in an application filed with a county sheriff pursuant to section 2923.125 of the Revised Code in order to obtain or renew a license to carry a concealed handgun or is made in an affidavit submitted to a county sheriff to obtain a temporary emergency license to carry a concealed handgun under section 2923.1213 of the Revised Code.
(16) The statement is required under section 5743.72 of the Revised Code in connection with the person's purchase of cigarettes or tobacco products in a delivery sale.
(B) No person, in connection with the purchase of a firearm, as defined in section 2923.11 of the Revised Code, shall knowingly furnish to the seller of the firearm a fictitious or altered driver's or commercial driver's license or permit, a fictitious or altered identification card, or any other document that contains false information about the purchaser's identity.
(C) No person, in an attempt to obtain a license to carry a concealed handgun under section 2923.125 of the Revised Code, shall knowingly present to a sheriff a fictitious or altered document that purports to be certification of the person's competence in handling a handgun as described in division (B)(3) of section 2923.125 of the Revised Code.
(D) It is no defense to a charge under division (A)(6) of this section that the oath or affirmation was administered or taken in an irregular manner.
(E) If contradictory statements relating to the same fact are made by the offender within the period of the statute of limitations for falsification, it is not necessary for the prosecution to prove which statement was false but only that one or the other was false.
(F)(1) Whoever violates division (A)(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (13), (14), or (16) of this section is guilty of falsification, a misdemeanor of the first degree.
(2) Whoever violates division (A)(9) of this section is guilty of falsification in a theft offense. Except as otherwise provided in this division, falsification in a theft offense is a misdemeanor of the first degree. If the value of the property or services stolen is five hundred dollars or more and is less than five thousand dollars, falsification in a theft offense is a felony of the fifth degree. If the value of the property or services stolen is five thousand dollars or more and is less than one hundred thousand dollars, falsification in a theft offense is a felony of the fourth degree. If the value of the property or services stolen is one hundred thousand dollars or more, falsification in a theft offense is a felony of the third degree.
(3) Whoever violates division (A)(12) or (B) of this section is guilty of falsification to purchase a firearm, a felony of the fifth degree.
(4) Whoever violates division (A)(15) or (C) of this section is guilty of falsification to obtain a concealed handgun license, a felony of the fourth degree.
(G) A person who violates this section is liable in a civil action to any person harmed by the violation for injury, death, or loss to person or property incurred as a result of the commission of the offense and for reasonable attorney's fees, court costs, and other expenses incurred as a result of prosecuting the civil action commenced under this division. A civil action under this division is not the exclusive remedy of a person who incurs injury, death, or loss to person or property as a result of a violation of this section.
Sec. 5110.01.  As used in this chapter:
(A) "Administrative fee" means the amount specified in rules adopted under division (G) of section 5110.35 of the Revised Code.
(B) "Children's health insurance program" means the children's health insurance program part I and part II established under sections 5101.50 to 5101.5110 of the Revised Code.
(C)(B) "Disability medical assistance program" means the program established under section 5115.10 of the Revised Code.
(D)(C) "Medicaid program" or "medicaid" means the medical assistance program established under Chapter 5111. of the Revised Code.
(E)(D) "National drug code number" means the number registered for a drug pursuant to the listing system established by the United States food and drug administration under the "Drug Listing Act of 1972," 86 Stat. 559, 21 U.S.C. 360, as amended.
(F) "Ohio's best Rx program administrator" means the entity, if any, the department of job and family services contracts with pursuant to section 5110.10 of the Revised Code to perform administrative functions of the Ohio's best Rx program and to offer the mail order system through which Ohio's best Rx program participants may obtain drugs by mail.
(G) "Ohio's best Rx program applicant" or "applicant" means an individual who signs an application for the Ohio's best Rx program and submits it to the department of job and family services, or the Ohio's best Rx program administrator, for a determination of eligibility for the program.
(H)(E) "Ohio's best Rx program participant" or "participant" means an individual determined eligible for the Ohio's best Rx program and included under a valid an Ohio's best Rx program enrollment card.
(I) "Ohio's best Rx program price" means the price a participating terminal distributor is to charge an Ohio's best Rx program participant for a drug included in the Ohio's best Rx program as determined under section 5110.14 of the Revised Code. "Ohio's best Rx program price" does not include either of the following:
(1) The amount of the professional fee, if any, the participating terminal distributor adds to the Ohio's best Rx program price pursuant to an agreement under section 5110.12 of the Revised Code;
(2) The amount of the administrative fee, if any, the department of job and family services reports to the participating terminal distributor under section 5110.29 of the Revised Code.
(J)(F) "Participating manufacturer" means a drug manufacturer participating in the Ohio's best Rx program pursuant to a rebate manufacturer agreement entered into under section 5110.26 of the Revised Code.
(K)(G) "Participating terminal distributor" means a terminal distributor of dangerous drugs participating in the Ohio's best Rx program pursuant to an agreement entered into with the department of job and family services under section 5110.12 5110.20 of the Revised Code.
(L) "Per unit price," with regard to a state health benefit plan or state retirement system health benefit plan, means the total amount paid to a terminal distributor of dangerous drugs under a state health benefit plan or state retirement system health benefit plan for one unit of a drug covered by the plan, after the plan discounts or otherwise reduces the amount to be paid to the terminal distributor. "Per unit price" includes both of the following:
(1) The amount that the state health benefit plan or state retirement system health benefit plan, or other government entity or person authorized to make the payment on behalf of the plan, pays to the terminal distributor of dangerous drugs;
(2) The amount that the beneficiary of the state health benefit plan or state retirement system health benefit plan pays to the terminal distributor of dangerous drugs in the form of a copayment, coinsurance, or other cost-sharing charge.
(M) "Per unit rebate," with regard to a state health benefit plan or state retirement system health benefit plan, means all rebates, discounts, formulary fees, administrative fees, and other allowances a drug manufacturer pays to the plan, or other government entity or person authorized to receive all or part of such payments, for a drug during a calendar year, divided by the total number of units of that drug dispensed under the plan during the same calendar year.
(N) "Rebate administration percentage" means the percentage specified in rules adopted under division (K) of section 5110.35 of the Revised Code.
(O) "Rebate agreement" means an agreement under section 5110.21 of the Revised Code between the department of job and family services and a drug manufacturer.
(P) "State health benefit plan" means a program of health care benefits offered through the Ohio med preferred provider organization, or a successor entity selected by the state, to which either of the following apply:
(1) It is provided by a collective bargaining agreement authorized by division (A)(4) of section 4117.03 of the Revised Code.
(2) It is offered by the department of administrative services to state employees in accordance with section 124.81 or 124.82 of the Revised Code.
(Q) "State retirement system" means all of the following: the public employees retirement system, state teachers retirement system, school employees retirement system, Ohio police and fire pension fund, and state highway patrol retirement system.
(R) "State retirement system health benefit plan" means a plan of health care benefits offered by a state retirement system under section 145.58, 742.45, 3307.39, 3309.69, or 5505.28 of the Revised Code.
(S)(H) "Political subdivision" has the same meaning as in section 9.23 of the Revised Code.
(I) "State agency" has the same meaning as in section 9.23 of the Revised Code.
(J) "Terminal distributor of dangerous drugs" has the same meaning as in section 4729.01 of the Revised Code.
(T)(K) "Third-party payer" has the same meaning as in section 3901.38 of the Revised Code.
(U)(L) "Trade secret" has the same meaning as in section 1333.61 of the Revised Code.
(V)(M) "Usual and customary charge" means the amount a participating terminal distributor or the Ohio's best Rx program administrator drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code charges for when a drug included in the program to is purchased by an individual who does not receive a discounted price for the drug pursuant to any drug discount program, including the Ohio's best Rx program, a prescription drug discount card program established under section 173.061 of the Revised Code, or a pharmacy assistance program established by any person or government entity, and for whom no third-party payer or program funded in whole or part with state or federal funds is responsible for all or part of the cost of the drug the distributor dispenses to the individual.
Sec. 5110.02. There is hereby established the Ohio's best Rx program for the purpose of providing outpatient prescription drug discounts to individuals residing in this state who are enrolled in the program by meeting the eligibility requirements specified in section 5110.14 of the Revised Code, including eligible individuals who are sixty years of age or older, eligible individuals who have low incomes but are not eligible for medicaid, and other eligible individuals who do not have health benefits that cover outpatient drugs. The program shall include all drugs that are included in a manufacturer agreement entered into under section 5110.26 of the Revised Code and all other drugs that may be dispensed only pursuant to a prescription issued by a licensed health professional authorized to prescribe drugs, as defined in section 4729.01 of the Revised Code. Except as provided in section 5110.10 of the Revised Code, the department of job and family services shall administer the program.
Sec. 5110.021. (A) Except as provided in division (B) of this section, the Ohio's best Rx program shall be administered by the department of job and family services.
(B)(1) The department may enter into a contract with any person under which the person serves as the administrator of the Ohio's best Rx program. Before entering into a contract for a program administrator, the department shall issue a request for proposals from persons seeking to be considered. The department shall develop a process to be used in issuing the request for proposals, receiving responses to the request, and evaluating the responses on a competitive basis. In accordance with that process, the department shall select the person to be awarded the contract.
(2) Subject to divisions (B)(5) and (6) of this section, the department may delegate to the person awarded the contract any of the department's powers or duties specified in this chapter or any other provision of the Revised Code pertaining to the Ohio's best Rx program. The terms of the contract shall specify the extent to which the powers or duties are delegated to the program administrator.
(3) In exercising powers or performing duties delegated under the contract, the program administrator is subject to the same provisions of this chapter or other provisions of the Revised Code that grant the powers or duties to the department, as well as any limitations or restrictions that are applicable to or associated with those powers or duties.
(4) Wherever the department is referred to in this chapter or another provision of the Revised Code relative to a power or duty delegated to the program administrator, both of the following apply:
(a) If the department has delegated the power or duty in whole to the program administrator, the reference to the department is, instead, a reference to the administrator.
(b) If the department retains any part of the power or duty that is delegated to the program administrator, the reference to the department is a reference to both the department and the administrator.
(5) The terms of a contract for a program administrator shall include provisions for offering the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code. The terms of the contract may permit the administrator to offer the drug mail order system by contracting with another person.
(6) The department shall not delegate to a program administrator the department's powers or duties to do any of the following:
(a) Enter into contracts under this section other than a contract to offer a drug mail order system;
(b) Receive verification of drug pricing information under section 5110.09 of the Revised Code or verification of drug manufacturer payment information under section 5110.30 of the Revised Code from the pharmacy benefit manager selected under section 5110.04 of the Revised Code to serve as the Ohio's best Rx program's consulting pharmacy benefit manager;
(c) Request the program's consulting pharmacy benefit manager to provide for an audit under section 5110.05 of the Revised Code;
(d) Review or use any information contained in or pertaining to an audit provided for by the program's consulting pharmacy benefit manager other than the audit's findings of whether the consulting pharmacy benefit manager provided valid information when providing drug pricing verification services or drug manufacturer payment verification services;
(e) Adopt rules under section 5110.35 or 5110.36 of the Revised Code;
(f) Employ an ombudsperson pursuant to section 5110.40 of the Revised Code.
Sec. 5110.03. (A) Any entity that provides services as a pharmacy benefit manager relative to the outpatient drug coverage included in a health benefit plan offered to the employees or retirees of a state agency or political subdivision and the eligible dependents of those employees or retirees shall provide drug pricing verification services under section 5110.09 of the Revised Code and drug manufacturer payment verification services under section 5110.30 of the Revised Code if the entity is selected under section 5110.04 of the Revised Code by the department of job and family services to serve as the Ohio's best Rx program's consulting pharmacy benefit manager for purposes of providing the verification services.
(B) Both of the following apply to the entity selected to serve as the Ohio's best Rx program's consulting pharmacy benefit manager:
(1) The entity shall provide the drug pricing verification services and drug manufacturer payment verification services without charge, either to the Ohio's best Rx program or to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.
(2) The entity shall provide the verification services for the entire year for which it is selected to serve as the program's consulting pharmacy benefit manager, regardless of the duration or termination of its responsibility to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.
(C) If the entity selected to serve as the consulting pharmacy benefit manager fails to provide the program with drug pricing verification services or drug manufacturer payment verification services, or fails to provide for an audit when requested to do so under section 5110.05 of the Revised Code, the department may ask the attorney general to bring an action for injunctive relief in any court of competent jurisdiction. On the filing of an appropriate petition in the court, the court shall conduct a hearing on the petition. If it is demonstrated in the proceedings that the pharmacy benefit manager has failed to provide the verification services or has failed to provide for the audit, the court shall grant a temporary or permanent injunction enjoining the pharmacy benefit manager from continuing to fail to provide the verification services or from continuing to fail to provide for the audit.
(D) This section does not impose any duty on the state agency or political subdivision for which an entity provides services as a pharmacy benefit manager.
Sec. 5110.04. Annually, the department of job and family services shall select a pharmacy benefit manager, from among the pharmacy benefit managers subject to section 5110.03 of the Revised Code, to serve as the Ohio's best Rx program's consulting pharmacy benefit manager for purposes of providing drug pricing verification services under section 5110.09 of the Revised Code and drug manufacturer payment verification services under section 5110.30 of the Revised Code. The department shall select the pharmacy benefit manager that the department considers to be the most appropriate pharmacy benefit manager to provide the verification services for the Ohio's best Rx program. In making the selection, the department shall consider the pharmacy benefit manager that provides services relative to the outpatient drug coverage included in the health benefit plan offered to the greatest number of employees or retirees of a state agency or political subdivision and the eligible dependents of those employees or retirees.
The department shall provide written notice to the pharmacy benefit manager that it has been selected to serve as the Ohio's best Rx program's consulting pharmacy benefit manager. The notice shall specify the date on which the pharmacy benefit manager is to begin serving as the program's consulting pharmacy benefit manager for the ensuing year.
Before the end of the one-year period during which a pharmacy benefit manager is to serve as the program's consulting pharmacy benefit manager, the department shall make another selection in accordance with this section. In making the selection, the department may select the same pharmacy benefit manager to serve as the program's consulting pharmacy benefit manager or may select another pharmacy benefit manager.
Sec. 5110.05. (A) To determine whether the pharmacy benefit manager selected under section 5110.04 of the Revised Code to serve as the Ohio's best Rx program's consulting pharmacy benefit manager has provided valid information when providing drug pricing verification services under section 5110.09 of the Revised Code or drug manufacturer payment verification services under section 5110.30 of the Revised Code, the department of job and family services may request that the consulting pharmacy benefit manager provide for an audit of its relevant contracts with drug manufacturers and terminal distributors of dangerous drugs.
In making audit requests under this section, both of the following apply:
(1) The department may request an audit on a regularly occurring basis, but not more frequently than once every three years.
(2) The department may request an audit at any time it has a reasonable basis to believe that the consulting pharmacy benefit manager is not acting in good faith in providing drug pricing verification services or drug manufacturer payment verification services. Notice of the request shall be made in writing and signed by the director of job and family services. The notice may specify the basis for the belief that the consulting pharmacy benefit manager is not acting in good faith. If the basis for the belief is not specified and the audit findings demonstrate that the consulting pharmacy benefit manager acted in good faith, the department shall pay the cost incurred by the consulting pharmacy benefit manager in providing for the audit.
(B) An audit provided for under this section shall be performed only by an auditor that is mutually satisfactory to the department and consulting pharmacy benefit manager and independent of both the department and consulting pharmacy benefit manager.
(C) If the findings of an audit provided for under this section demonstrate that the verification services provided by the consulting pharmacy benefit manager did not result in valid information, the department shall use the audit findings for purposes of confirming the validity of the one or more drug pricing formulas designated under section 5110.08 of the Revised Code and entering into agreements with drug manufacturers under section 5110.26 of the Revised Code.
Sec. 5110.07. Annually, the department of job and family services shall establish a base price for each drug included in the Ohio's best Rx program. In the case of drugs dispensed by a terminal distributor of dangerous drugs that has entered into an agreement under section 5110.20 of the Revised Code, the base price shall be established by using the one or more formulas designated under section 5110.08 of the Revised Code. In the case of the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code, the base price shall be established in accordance with the rules adopted under section 5110.35 of the Revised Code governing the drug mail order system.
Sec. 5110.08. Annually, the department of job and family services shall designate one or more formulas for use in establishing under section 5110.07 of the Revised Code the Ohio's best Rx program's base price for drugs dispensed by a terminal distributor of dangerous drugs that has entered into an agreement under section 5110.20 of the Revised Code. Each formula shall include a drug pricing discount component that is expressed as a percentage discount. The formula used for generic drugs may include the maximum allowable cost limits that apply to generic drugs under the medicaid program.
In designating the one or more formulas, the department shall use the best information on drug pricing that is available to the department, including information obtained through the drug pricing verification services provided under section 5110.09 of the Revised Code by the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code. Based on the available information, the department shall modify the one or more formulas as it considers appropriate to maximize the benefits provided to Ohio's best Rx program participants.
Sec. 5110.09. For purposes of section 5110.08 of the Revised Code, the department of job and family services shall obtain verification of drug pricing information from the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code. The information shall be obtained in accordance with the following procedures:
(A) For brand name drugs, excluding generic drugs marketed under brand names, the department shall submit to the consulting pharmacy benefit manager the formula the department proposes to use to establish the program's base price for brand name drugs during the year.
The consulting pharmacy benefit manager shall review the formula submitted by the department. In conducting the review, the consulting pharmacy benefit manager shall compare the drug pricing discount percentage included in the department's formula to the drug pricing discount percentage included in the formula most commonly used by the consulting pharmacy benefit manager to establish part of its payment rate for brand name drugs dispensed by terminal distributors of dangerous drugs other than drug mail order systems. If the formulas are not expressed in equivalent terms, the consulting pharmacy benefit manager shall make all accommodations necessary to make the comparison of the discount percentages.
After conducting the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether the discount percentage included in the department's formula is more than two percentage points below the discount percentage included in the formula used by the consulting pharmacy benefit manager. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
(B) For generic drugs, the department shall identify the fifty generic drugs most frequently purchased by Ohio's best Rx program participants in the immediately preceding year from terminal distributors of dangerous drugs other than the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code. The department shall submit to the consulting pharmacy benefit manager the names of the fifty drugs, the number of prescriptions filled for each of the drugs, the formula used to compute the base price for the drugs during the year, and the weighted average base price for the drugs that resulted for the year.
The consulting pharmacy benefit manager shall review the submitted information. In conducting the review, the consulting pharmacy benefit manager shall compare the department's weighted average base price to the equivalent part of the consulting pharmacy benefit manager's weighted average payment rate for the same drugs when dispensed by terminal distributors of dangerous drugs other than drug mail order systems. For purposes of the comparison, the department and consulting pharmacy benefit manager shall express the weighted average base price and payment rate in terms of a discount percentage that is taken from the drugs' average wholesale price, as identified by a national drug price reporting service selected by the department and the consulting pharmacy benefit manager.
After conducting the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether the discount percentage reflected in the department's weighted average base price for the drugs is more than two percentage points below the equivalent part of the consulting pharmacy benefit manager's weighted average payment rate for the same drugs. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
Sec. 5110.10. (A) Subject to division (B) of this section, the amount that an Ohio's best Rx program participant is to be charged for a quantity of a drug purchased under the program shall be established in accordance with all of the following:
(1) If the drug is not included in a manufacturer agreement entered into under section 5110.26 of the Revised Code, the participant shall be charged an amount that is computed according to the drug's base price established under section 5110.07 of the Revised Code.
(2) If the drug is included in a manufacturer agreement entered into under section 5110.26 of the Revised Code, the participant shall be charged an amount that is computed by subtracting from the drug's base price established under section 5110.07 of the Revised Code the amount of the manufacturer payment that applies to the transaction, as established under section 5110.28 of the Revised Code.
(3) If an administrative fee is specified in rules adopted under section 5110.35 of the Revised Code, the participant shall be charged the amount of the administrative fee.
(4) If the drug is dispensed by a terminal distributor of dangerous drugs under an agreement entered into under section 5110.20 of the Revised Code, and the terminal distributor charges a professional fee pursuant to the agreement, the participant shall be charged the amount of the professional fee.
(5) If the drug is dispensed through the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code, the participant shall not be charged a professional fee.
(B) When a quantity of a drug is purchased by an Ohio's best Rx program participant, the participating terminal distributor or drug mail order system dispensing the drug shall charge the lesser of the amount that applies to the transaction, as established in accordance with division (A) of this section, or the usual and customary charge that otherwise would apply to the transaction. When a drug is purchased at the usual and customary charge pursuant to this division, the transaction is not subject to this chapter as the purchase or dispensing of a drug under the program.
Sec. 5110.29 5110.11 The department of job and family services shall report all of the following to each participating terminal distributor and the Ohio's best Rx program administrator drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code in a manner enabling the distributor and administrator system to comply with section 5110.14 5110.10 of the Revised Code:
(A) For each drug included in the Ohio's best Rx program that is not covered by a rebate agreement under section 5110.21 of the Revised Code, the results of the department's computations under division (A) of section 5110.27 of the Revised Code.
(B) For each drug included in the program that is covered by a rebate agreement entered into under section 5110.21 of the Revised Code, the results of the department's computations under division (C) of section 5110.27 of the Revised Code.
(C), the amount to be charged under division (A)(1) or (2) of section 5110.10 of the Revised Code;
(B) The administrative fee, if any, determined specified by the department in accordance with rules adopted under section 5110.35 of the Revised Code.
Sec. 5110.12. The amount that an Ohio's best Rx program participant saves when a drug is purchased under the program shall be determined by subtracting the amount that the participant is charged in accordance with division (A) of section 5110.10 of the Revised Code from the usual and customary charge that otherwise would apply to the transaction.
Sec. 5110.39 5110.13 Not later than the first day of March of each year, the department of job and family services shall do all of the following:
(A) Create a list of the twenty-five drugs most often dispensed to Ohio's best Rx program participants under the program, using data from the most recent six-month period for which the data is available;
(B) Determine the average amount that participating terminal distributors charge participants are charged under the program, on a date selected by the department, participants for each drug included on the list created under division (A) of this section;
(C) Determine, for the date selected for division (B) of this section, the average usual and customary charge of participating terminal distributors for each drug included on the list created under division (A) of this section;
(D) By comparing the average charges determined under divisions (B) and (C) of this section, determine the average percentage savings in the amount participating terminal distributors charge Ohio's best Rx program participants receive for each drug included on the list created under division (A) of this section.
Sec. 5110.05 5110.14(A) To be eligible for the Ohio's best Rx program, an individual must meet all of the following requirements at the time of application or reapplication for the program:
(1) Be The individual must be a resident of this state;.
(2) Have Either of the following must be the case:
(a) The individual has family income, as determined under rules adopted pursuant to section 5110.35 of the Revised Code, that does not exceed two three hundred fifty per cent of the federal poverty guidelines, as revised annually by the United States department of health and human services in accordance with section 673(2) of the "Omnibus Budget Reconciliation Act of 1981," 95 Stat. 511, 42 U.S.C. 9902, as amended, or be;
(b) The individual is sixty years of age or older;.
(3) Not Except as provided in division (B) of this section, the individual must not have coverage for outpatient prescription drug coverage drugs paid for in whole or in part by any of the following:
(a) A third-party payer, including an employer;
(b) The medicaid program;
(c) The children's health insurance program;
(d) The disability medical assistance program;
(e) Another health plan or pharmacy assistance program that uses state or federal funds to pay part or all of the cost of the individual's outpatient prescription drugs, other than a prescription drug discount card program established under section 173.061 of the Revised Code.
(4) Not The individual must not have had coverage for outpatient prescription drug coverage drugs paid for by any of the entities or programs specified in division (A)(3) of this section during any of the four months preceding the month in which the application or reapplication for the Ohio's best Rx program is made, unless any of the following applies:
(a) The individual is sixty years of age or older.
(b) The third-party payer, including an employer, that paid all or part of for the coverage filed for bankruptcy under federal bankruptcy laws.
(c) The individual is no longer eligible for coverage provided through a retirement plan subject to protection under the "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C. 1001, as amended.
(d) The individual is no longer eligible for the medicaid program, children's health insurance program, or disability medical assistance program.
(e) The individual is either temporarily or permanently discharged from employment due to a business reorganization.
(B) Application and annual reapplication for the Ohio's best Rx program shall be made in accordance with rules adopted under section 5110.35 of the Revised Code on a form prescribed in those rules. An individual may apply or reapply on behalf of the individual and the individual's spouse and children. The guardian or custodian of an individual may apply or reapply on behalf of the individual An individual is not subject to division (A)(3) of this section if the individual has coverage for outpatient drugs paid for in whole or in part by any of the following:
(1) A prescription drug discount card program established under section 173.061 of the Revised Code;
(2) The workers' compensation program;
(3) A medicare prescription drug plan offered pursuant to the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003," 117 Stat. 2071, 42 U.S.C. 1395w-101, as amended, but only if all of the following are the case with respect to the particular drug being purchased through the Ohio's best Rx program:
(a) The individual is responsible for the full cost of the drug.
(b) The drug is not subject to a rebate from the manufacturer under the individual's medicare prescription drug plan.
(c) The manufacturer of the drug has agreed to the Ohio's best Rx program's inclusion of individuals who have coverage through a medicare prescription drug plan.
Sec. 5110.15. Application for participation in the Ohio's best Rx program shall be made in accordance with rules adopted by the department of job and family services under section 5110.35 of the Revised Code. When applying for participation, an individual may include application for participation by the individual's spouse and children. An individual's guardian or custodian may apply on behalf of the individual.
When submitting an application, the applicant shall include the information and documentation specified in the department's rules as necessary to verify eligibility for the program. The application may be submitted on a paper form prescribed and supplied by the department or pursuant to any other application method the department makes available for the program, including methods that permit an individual to apply by telephone or through the internet.
An applicant shall attest that the information and documentation the applicant submits with an application is accurate to the best knowledge and belief of the applicant. In the case of a paper application form, the applicant's signature shall be used to certify that the applicant has attested to the accuracy of the information and documentation. In the case of other application methods, the application certification process specified in the department's rules shall be used to certify that the applicant has attested to the accuracy of the information and documentation.
The department shall inform each applicant that knowingly making a false statement in an application is falsification under section 2921.13 of the Revised Code, a misdemeanor of the first degree. In the case of a paper application form, the department shall provide the information by including on the form a statement printed in bold letters.
Sec. 5110.07 5110.16 The department of job and family services shall provide each applicant for the Ohio's best Rx program information about the medicaid program in accordance with rules adopted under section 5110.35 of the Revised Code. The information shall include general eligibility requirements, application procedures, and benefits. The information shall also explain the ways in which the medicaid program's drug benefits are better than the Ohio's best Rx program.
Sec. 5110.08 5110.17On receipt of applications and annual reapplications, the department of job and family services shall make eligibility determinations for the Ohio's best Rx program in accordance with procedures established in rules adopted under section 5110.35 of the Revised Code. Each determination that an individual is eligible is valid for one year beginning on a date determined in accordance with the eligibility determination procedures. The beginning date may not precede the date on which the individual's eligibility is determined. Annual reapplication may be made under division (B) of section 5110.05 of the Revised Code if the individual seeks to continue to participate in the program after the date eligibility would otherwise end.
An eligibility determination under this section may not be appealed under Chapter 119., section 5101.35, or any other provision of the Revised Code.
Sec. 5110.09 5110.18(A) The department of job and family services shall issue Ohio's best Rx program enrollment cards to or on behalf of individuals determined eligible to participate. One enrollment card may cover each member of a family determined eligible to participate. The card is valid only during the period each individual covered by the card is eligible to participate. The card shall be presented to a participating terminal distributor each
The department shall determine the information to be included on the card, including an identification number, and shall determine the card's size and format. If the department establishes an application method that permits individuals to apply through the internet, the department may issue the enrollment card by sending the applicant an electronic version of the card in a printable format.
(B) Each time a drug included in the program is purchased under the program, the entity dispensing the drug shall confirm whether the individual for whom the drug is dispensed is enrolled in the program. If the drug is being purchased from a participating terminal distributor rather than the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code, and the individual's enrollment card is available for presentation at the time of the purchase, the purchaser shall present the card to the participating terminal distributor as confirmation of the individual's enrollment in the program. If the drug is being purchased through the drug mail order system and the individual's program identification number is available, the purchaser shall present the identification number as confirmation of enrollment. Otherwise, the terminal distributor or mail order system shall confirm the individual's enrollment through the department. The department shall establish the methods to be used in confirming enrollment through the department, including confirmation by telephone, through the internet, or by any other electronic means.
(C) Purchasing a drug under the program by using an enrollment card or any other method shall serve as an attestation by the participant for whom the drug is dispensed that the participant meets the eligibility requirements specified in division (A)(3) of section 5110.14 of the Revised Code regarding not having coverage for outpatient drugs.
Sec. 5110.19. (A) For purposes of making drugs included in the Ohio's best Rx program available to participants by mail, the department of job and family services shall include a drug mail order system within the program. Not more than one drug mail order system shall be included in the program. Subject to division (B) of this section, the program's drug mail order system shall be provided in accordance with rules adopted under section 5110.35 of the Revised Code.
(B) Neither the department nor the drug mail order system shall promote the purchase of drugs through the system by using information collected under the program regarding the drugs purchased by participants from participating terminal distributors. This division does not preclude the use of the information for purposes of limiting the amount that a participant may be charged for a quantity of a drug purchased through the drug mail order system to an amount that is not more than the amount that would be charged if the same quantity of the drug were purchased from a participating terminal distributor.
Sec. 5110.12 5110.20 A (A) For purposes of making drugs included in the Ohio's best Rx program available to participants from terminal distributors of dangerous drugs other than the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code, the department of job and family services shall enter into agreements under this section with terminal distributors of dangerous drugs. Any terminal distributor of dangerous drugs may enter into an agreement with the department of job and family services to participate in the Ohio's best Rx program for purposes of dispensing drugs pursuant to this section. Before
Before entering into an agreement with a terminal distributor, the department shall provide the terminal distributor with a one of the following:
(1) A formula that allows the terminal distributor to calculate the price of for each drug included in the program, a the amount to be charged under division (A)(1) or (2) of section 5110.10 of the Revised Code by participating terminal distributors.
(2) A statistically valid sampling of drug prices that includes the prices of amount to be charged under division (A)(1) or (2) of section 5110.10 of the Revised Code by participating terminal distributors for not less fewer than two branded brand name drugs and two generic drugs from each category of drugs included in the program, or the.
(3) The current Ohio's best Rx program price amount to be charged under division (A)(1) or (2) of section 5110.10 of the Revised Code by participating terminal distributors for each drug included in the program.
(B) An agreement entered into under this section shall do all of the following:
(A)(1) Except as provided in division (C)(B)(3) of this section, be in effect for not less than one year;
(B)(2) Specify the dates that the agreement is to begin and end;
(C)(3) Permit the participating terminal distributor to terminate the agreement before the date the agreement would otherwise end as specified pursuant to division (B)(2) of this section by providing the department notice of early termination at least thirty days before the effective date of the early termination;
(D)(4) Require that the participating terminal distributor charge an Ohio's best Rx program participant for each drug included in the program the lesser of (1) the sum of the Ohio's best Rx program price as determined under section 5110.14 of the Revised Code, the professional fee under division (E) of this section, if any, and the administrative fee under division (F) of this section, if any, or (2) the terminal distributor's usual and customary charge comply with section 5110.10 of the Revised Code when charging for a drug purchased under the program;
(E)(5) Permit the participating terminal distributor to add to the Ohio's best Rx program price amount to be charged under division (A)(1) or (2) of section 5110.10 of the Revised Code a professional fee in an amount not to exceed, except as provided in rules adopted under section 5110.35 of the Revised Code, three dollars;
(F) Require the participating terminal distributor to add to the Ohio's best Rx program price an administrative fee, in an amount determined in accordance with rules adopted under section 5110.35 of the Revised Code, for each transaction in which a quantity of the drug is dispensed if an administrative fee is required by those rules;
(G)(6) Require the participating terminal distributor to disclose to each participant the amount the participant saves under the program as determined in accordance with section 5110.15 5110.12 of the Revised Code;
(H)(7) Require the participating terminal distributor to submit a claim to the department under section 5110.16 5110.22 of the Revised Code for each sale of a drug to a participant;
(I)(8) Permit the participating terminal distributor to deliver drugs to Ohio's best Rx program participants by mail, but not by using a drug mail order system operated in the same manner as the system included in the program pursuant to section 5110.19 of the Revised Code.
Sec. 5110.13 5110.21The department of job and family services may not prohibit a A terminal distributor of dangerous drugs shall not be prohibited from participating in any other program the department administers or any network of health care providers on the basis that the terminal distributor has not entered into an agreement under section 5110.12 5110.20 of the Revised Code to participate in the Ohio's best Rx program.
No entity under contract with the department under section 5110.10 of the Revised Code may prohibit a terminal distributor of dangerous drugs from participating in a program or network the entity administers or operates on the basis that the terminal distributor has not entered into an agreement under section 5110.12 of the Revised Code.
Sec. 5110.16 5110.22A participating terminal distributor or the Ohio's best Rx program administrator shall submit For each drug dispensed under the Ohio's best Rx program, a claim shall be submitted to the department of job and family services for each drug dispensed to an Ohio's best Rx program participant. The participating terminal distributor or the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code that dispensed the drug shall submit the claim not later than thirty days after the drug is dispensed. The claim shall be submitted in accordance with the electronic method provided for in rules adopted under section 5110.35 of the Revised Code.
The claim shall specify all of the following:
(A) The prescription number of the participant's prescription under which the drug is was dispensed to the participant;
(B) The name of, and national drug code number for, the drug dispensed to the participant;
(C) The number of units of the drug dispensed to the participant;
(D) The amount the distributor or administrator charged the participant was charged for the drug;
(E) The date that the distributor or administrator dispensed the drug was dispensed to the participant;
(F) Any additional information required by rules adopted under section 5110.35 of the Revised Code.
Sec. 5110.17 5110.23(A) In accordance with rules adopted under section 5110.35 of the Revised Code and subject to section 5110.19 5110.25 of the Revised Code, the department of job and family services shall pay a participating terminal distributor or the Ohio's best Rx program administrator make payments under the Ohio's best Rx program for complete and timely claims submitted under section 5110.22 of the Revised Code for drugs included in the program that are covered by also included in a rebate manufacturer agreement entered into under section 5110.21 5110.26 of the Revised Code. The payment for a complete and timely claim shall be made by a date that is not later than two weeks after the claim is received by the department receives the claim from the participating terminal distributor or the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code.
(B) Subject to division (D) of this section, the amount to be paid for a claim for a drug dispensed under the program shall be determined as follows:
(1) Multiply Compute the rebate manufacturer payment amount for that applies to the transaction, based on quantity of the drug dispensed and the drug's national drug code number for the drug for which the claim is made, as agreed to under division (B)(4)(a) of section 5110.21 of the Revised Code or computed under division (B) of section 5110.27 of the Revised Code, as applicable, by the number of units of the drug dispensed to the Ohio's best Rx program participant, in accordance with the provisions of division (B) of section 5110.28 of the Revised Code;
(2) If rules adopted under section 5110.35 of the Revised Code require that program participants be charged an administrative fee was charged, for each transaction in which a quantity of the drug was dispensed, subtract from the amount computed under division (B)(1) of this section the administrative fee amount specified in those rules adopted under section 5110.35 of the Revised Code.
(C) The department may combine the claims from submitted by a participating terminal distributor or the administrator program's drug mail order system to make aggregate payments under this section to the distributor or administrator system.
(D) If the total of the amounts computed under division (B) of this section for any period for which payments are due is a negative number, the participating terminal distributor or administrator the program's drug mail order system that submitted the claims has been overpaid for the claims submitted under section 5110.16 of the Revised Code. When there is an overpayment, the department shall reduce future payments to the terminal distributor or administrator made under this section to the distributor or system or collect an amount from the terminal distributor or administrator system sufficient to reimburse the department for the overpayment.
Sec. 5110.18 5110.24 Neither the department of job and family services nor the Ohio's best Rx program administrator may charge a participating terminal distributor nor the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code may be charged by the department of job and family services for the submission of a claim under section 5110.22 of the Revised Code or the processing of a claim under sections 5110.16 and 5110.17 section 5110.23 of the Revised Code.
Sec. 5110.19 5110.25The department of job and family services may not make a payment under section 5110.17 5110.23 of the Revised Code for a claim submitted under section 5110.16 5110.22 of the Revised Code if any of the following are the case:
(A) The claim is submitted by either a terminal distributor of dangerous drugs that is neither not a participating terminal distributor nor the Ohio's best Rx program administrator or a drug mail order system that is not the system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code.
(B) The claim is for a drug that is not included in the program.
(C) The claim is for a drug included in the program but the drug is dispensed to an individual who is not covered by a valid an Ohio's best Rx program enrollment card.
(D) A person or government entity has paid the participating terminal distributor or the administrator program's drug mail order system through any other prescription drug coverage program or prescription drug discount program for dispensing the drug, unless the payment is reimbursement for redeeming a coupon or is an amount directly paid by a drug manufacturer to the terminal distributor or system for dispensing drugs to residents of a long-term care facility.
Sec. 5110.26. For purposes of participating in the Ohio's best Rx program, any drug manufacturer may enter into an agreement with the department of job and family services under which the manufacturer agrees to make payments to the department with respect to one or more of the manufacturer's drugs when the one or more drugs are dispensed under the program. The terms of the agreement shall comply with section 5110.27 of the Revised Code.
Sec. 5110.21 5110.27 (A) A manufacturer agreement entered into under section 5110.26 of the Revised Code by a drug manufacturer may enter into a rebate agreement with and the department of job and family services regarding drugs it manufactures. The agreement shall specify include terms that do all of the following:
(1) Specify the time it the agreement is to be in effect, which shall be not less than one year from the date the agreement is entered into.
(B) The agreement shall do all of the following:
(1);
(2) Specify which of the manufacturer's drugs are included in the agreement;
(2)(3) Permit the department to remove a drug from the agreement in the event of a dispute over the drug's utilization;
(3)(4) Require that the manufacturer make specify a rebate payment per unit amount that will be paid to the department for each drug specified under division (B)(1) of this section included in the agreement that is dispensed to an Ohio's best Rx program participant;
(4)(a)(5) Require that the per unit rebate be in an amount equal to the greater of the following:
(i) The weighted average of the per unit rebates for the drug as computed under division (C)(1) of this section;
(ii) A per unit amount specified by the manufacturer.
(b) Require that the rebate payment for a quantity of a drug dispensed to an Ohio's best Rx participant be equal to the amount determined by multiplying the applicable per unit rebate by the number of units dispensed.
(5) Specify the intervals at which the manufacturer will report to the department amounts specified pursuant to division (B)(4)(a)(ii) of this section;
(6) amount specified by the manufacturer be an amount that the manufacturer believes is greater than or comparable to the per unit amount generally payable by the manufacturer for the same drug when the drug is dispensed to an individual using the outpatient drug coverage included in a health benefit plan offered in this state or another state to public employees or retirees and the eligible dependents of those employees or retirees;
(6) Require the manufacturer to make payments in accordance with the amounts computed under division (A) of section 5110.28 of the Revised Code;
(7) Require that the manufacturer make the rebate payments to the department on a quarterly basis or in accordance with a schedule established by rules adopted under section 5110.35 of the Revised Code.
(C)(1) For the purposes of division (B)(4)(a)(i) of this section, once each year the department shall compute the weighted average of the per unit rebates for each drug using the information available to the department from submissions under division (A)(4) of section 5110.25 of the Revised Code. The computation shall be made in accordance with section 5110.28 of the Revised Code and rules adopted under section 5110.35 of the Revised Code.
(2) If no computation can be made under division (C)(1) of this section, the rebate for the drug shall be the amount specified under (B)(4)(a)(ii) of this section.
(D) On submission to the department by a manufacturer that has entered into a rebate agreement under this section of a request the department considers reasonable, the department shall permit the manufacturer to audit claims submitted under section 5110.16 of the Revised Code.
(B) For any drug included in a manufacturer agreement, the terms of the agreement may provide for the establishment of a process for referring Ohio's best Rx program applicants and participants to a patient assistance program operated or sponsored by the manufacturer. The referral process may be included only if the manufacturer agrees to refer to the Ohio's best Rx program residents of this state who apply but are found to be ineligible for the patient assistance program.
Sec. 5110.28. When a drug included in a manufacturer agreement entered into under section 5110.26 of the Revised Code is dispensed under the Ohio's best Rx program, the manufacturer payment amount that applies to the transaction shall be established in accordance with the following:
(A) For purposes of the amount to be paid by the manufacturer, the manufacturer payment amount shall be computed by multiplying the per unit amount specified for the drug in the manufacturer agreement by the number of units dispensed.
(B) For purposes of the amount that a participant is to be charged under section 5110.10 of the Revised Code and the amount to be paid for claims under section 5110.23 of the Revised Code, both of the following apply:
(1) If a program administration percentage is not determined by the department of job and family services in rules adopted under section 5110.35 of the Revised Code, the manufacturer payment amount shall be the same as the manufacturer payment amount computed under division (A) of this section.
(2) If a program administration percentage is determined by the department, the manufacturer payment amount shall be computed as follows:
(a) Multiply the per unit amount specified for the drug in the agreement by the program administration percentage;
(b) Subtract the product determined under division (B)(2)(a) of this section from the per unit amount specified for the drug in the agreement;
(c) Multiply the per unit amount resulting from the computation under division (B)(2)(b) of this section by the number of units dispensed.
Sec. 5110.29. In its negotiations with a drug manufacturer proposing to enter into an agreement under section 5110.26 of the Revised Code, the department of job and family services shall use the best information on manufacturer payments that is available to the department, including information obtained from the verifications made under section 5110.30 of the Revised Code by the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code. The department shall use the information in an attempt to obtain manufacturer payments that maximize the benefits provided to Ohio's best Rx program participants.
Sec. 5110.30. Annually, the department of job and family services shall select a sample of not more than ten of the drugs that were included in the manufacturer agreements entered into under section 5110.26 of the Revised Code in the immediately preceding year. The department shall submit to the program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code information that identifies the per unit amount of the manufacturer payments that applied to each of the drugs in the sample.
The consulting pharmacy benefit manager shall review the submitted information. After the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether any of the per unit payment amounts that applied to the selected drugs were more than two per cent lower than the per unit payment amounts negotiated by the consulting pharmacy benefit manager for the same drugs in connection with health benefit plans that generally do not use formularies to restrict the outpatient drug coverage included in the plans. The consulting pharmacy benefit manager shall specify which, if any, of the drugs in the sample were subject to the lower per unit payment amounts. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
Sec. 5110.31.  (A) The department of job and family services shall seek from the centers for medicare and medicaid services of the United States department of health and human services written confirmation that manufacturer payments made pursuant to an agreement entered into under section 5110.26 of the Revised Code are exempt from the medicaid best price computation applicable under Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396r-8, as amended.
(B) Entering into a manufacturer agreement under section 5110.26 of the Revised Code does not require a drug manufacturer to make a manufacturer payment that would establish the manufacturer's medicaid best price for a drug.
Sec. 5110.32. A drug manufacturer that enters into an agreement under section 5110.26 of the Revised Code may submit a request to the department of job and family services to audit claims submitted under section 5110.22 of the Revised Code. On submission of a request that the department considers reasonable, the department shall permit the manufacturer to audit the claims.
Sec. 5110.35.  The department of job and family services shall adopt rules in accordance with Chapter 119. of the Revised Code to implement the Ohio's best Rx program. The rules shall provide for all of the following:
(A) Standards and procedures for establishing, pursuant to section 5110.07 of the Revised Code, the base price for each drug included in the program;
(B) Determination of family income for the purpose of division (A)(2)(a) of section 5110.05 5110.14 of the Revised Code;
(B)(C) For the purpose of division (B) of section 5110.05 5110.15 of the Revised Code, the application and annual reapplication process for the program, including the information and documentation to be submitted with applications and reapplications for the purpose of verifying to verify eligibility and a process to be used in certifying that an applicant has attested to the accuracy of the submitted information and documentation;
(C) For the purpose of division (B) of section 5110.05 of the Revised Code and subject to section 5110.351 of the Revised Code, the application form for the program;
(D) The method of providing information about the medicaid program to applicants under section 5110.07 5110.16 of the Revised Code;
(E) For the purpose of section 5110.08 5110.17 of the Revised Code, eligibility determination procedures;
(F) Standards and procedures governing the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code;
(G) Subject to section 5110.352 of the Revised Code, periodically increasing the maximum professional fee that participating terminal distributors may charge Ohio's best Rx program participants pursuant to an agreement entered into under section 5110.12 5110.20 of the Revised Code or the Ohio's best Rx program administrator may charge under a contract entered into under section 5110.10 of the Revised Code;
(G)(H) Subject to section 5110.353 of the Revised Code, the amount of the administrative fee, if any, participating terminal distributors are to charge that Ohio's best Rx program participants under section 5110.12 of the Revised Code or the Ohio's best Rx program administrator may charge under a contract entered into under section 5110.10 of the Revised Code are to be charged under the program;
(H)(I) The electronic method for participating terminal distributors and the Ohio's best Rx program administrator to submit submission of claims to the department under section 5110.16 5110.22 of the Revised Code;
(I)(J) Additional information participating terminal distributors and the Ohio's best Rx program administrator shall include to be included on claims submitted under section 5110.16 5110.22 of the Revised Code that the department determines is necessary for the department to be able to make payments under section 5110.17 5110.23 of the Revised Code;
(J)(K) The method for making payments to participating terminal distributors or the Ohio's best Rx program administrator under section 5110.17 5110.23 of the Revised Code;
(K)(L) Subject to section 5110.354 of the Revised Code, the percentage, if any, that is the rebate program administration percentage;
(L)(M) If the department determines it is best that participating manufacturers make rebates payments pursuant to manufacturer agreements entered into under section 5110.21 5110.26 of the Revised Code on a basis other than quarterly, a schedule for payment of the rebates making the payments;
(M) The process for the department of administrative services and state retirement systems to calculate and submit the information required by section 5110.25 of the Revised Code;
(N) Procedures for making computations under sections 5110.21 5110.10 and 5110.27 5110.28 of the Revised Code;
(O) Standards and procedures for the use and preservation of records regarding the Ohio's best Rx program by the department and the Ohio's best Rx program administrator pursuant to section 5110.59 of the Revised Code;
(P) For the purpose of section 5110.10 of the Revised Code, the standards and procedures governing the operation of the mail order system by the Ohio's best Rx program administrator;
(Q) The efficient administration of other provisions of this chapter for which the department determines rules are necessary.
Sec. 5110.352.  As used in this section, "medicaid dispensing fee" means the dispensing fee established under section 5111.071 of the Revised Code for the medicaid program.
In adopting a rule under division (F) of section 5110.35 of the Revised Code increasing the maximum amount of the professional fee participating terminal distributors may charge Ohio's best Rx program participants pursuant to an agreement entered into under section 5110.12 5110.20 of the Revised Code and the Ohio's best Rx program administrator may charge under a contract entered into under section 5110.10 of the Revised Code, the department of job and family services shall review the amount of the professional fee once a year or, at the department's discretion, at more frequent intervals and. The department shall not increase the professional fee to an amount exceeding the medicaid dispensing fee.
A participating terminal distributor and the Ohio's best Rx program administrator may charge a maximum three dollar professional fee regardless of whether the medicaid dispensing fee for that drug is less than that amount. The department, however, may not adopt a rule increasing the maximum professional fee for that drug until the medicaid dispensing fee for that drug exceeds that amount.
Sec. 5110.353. (A) Once a year or, at the discretion of the department of job and family services, at more frequent intervals, the department shall determine the amount, if any, to be specified in a rule adopted under division (G) of section 5110.35 of the Revised Code as the administrative fee. In determining the amount of the administrative fee, the department shall determine an amount, not exceeding that each Ohio's best Rx program participant will be charged as an administrative fee to be used in paying the administrative costs of the program. The fee, which shall not exceed one dollar per transaction, shall be specified in rules adopted under section 5110.35 of the Revised Code. In adopting the rules, the department shall specify a fee that results in an amount that equals or is less than the amount needed to cover the administrative costs of the Ohio's best Rx program when added to the sum of the following:
(1) The amount resulting from the application of the rebate program administration percentage, if the department determines a program administration percentage in rules adopted under section 5110.35 of the Revised Code;
(2) The investment earnings of the Ohio's best Rx program fund created by section 5110.32 5110.42 of the Revised Code;
(3) Any amounts accepted by the department as donations to the Ohio's best Rx program fund.
(B) Once a year or, at the discretion of the department, at more frequent intervals, the department shall report the methodology underlying the determination of the administrative fee to the Ohio's best Rx program council.
Sec. 5110.354. (A) At least once a year or, at the discretion of the department of job and family services, at more frequent intervals, the department shall determine the percentage, if any, to be specified in a rule adopted under division (K) of section 5110.35 of the Revised Code as the rebate administration percentage of each manufacturer payment made under an agreement entered into under section 5110.26 of the Revised Code that will be retained by the department for use in paying the administrative costs of the Ohio's best Rx program. The percentage, which shall not exceed five per cent, shall result be specified in rules adopted under section 5110.35 of the Revised Code. In adopting the rules, the department shall specify a percentage that results in an amount that equals or is less than the amount needed to cover the administrative costs of the Ohio's best Rx program when added to the sum of the following:
(1) The amount resulting from administrative fee specified in fees, if the department determines an administrative fee in rules adopted under section 5110.353 5110.35 of the Revised Code;
(2) The investment earnings of the Ohio's best Rx program fund created by section 5110.32 5110.42 of the Revised Code;
(3) Any amounts accepted by the department as donations to the Ohio's best Rx program fund.
(B) Once a year or, at the discretion of the department, at more frequent intervals, the department shall report the methodology underlying the determination of the rebate program administration percentage to the Ohio's best Rx program council.
Sec. 5110.38.  The department of job and family services may coordinate the Ohio's best Rx program with a state any health benefit plan to enhance offered to the employees of state agencies and the eligible dependents of those employees, for purposes of enhancing efficiency, reduce reducing the cost of drugs, and maximize maximizing the benefits of the Ohio's best Rx program and state the health benefit plans plan.
Sec. 5110.39. The department of job and family services may establish a component of the Ohio's best Rx program under which subsidies are provided to participants to assist them with the cost of purchasing drugs under the program, including the cost of any professional fees charged for dispensing the drugs. The subsidies shall be provided only when the Ohio's best Rx program administration fund created under section 5110.43 of the Revised Code includes an amount that exceeds the amount necessary to pay the administrative costs of the program.
Sec. 5110.32 5110.42 (A) The Ohio's best Rx program fund is hereby created. The fund shall be in the custody of the treasurer of state, but shall not be part of the state treasury. The fund shall consist of the following:
(1) Rebate Manufacturer payments made by participating manufacturers made pursuant to agreements entered into under section 5110.21 5110.26 of the Revised Code;
(2) Administrative fees, if an administrative fee is determined by the department of job and family services in rules adopted under section 5110.35 of the Revised Code;
(3) Any amounts donated to the fund and accepted by the department;
(4) The fund's investment earnings.
(B) The department of job and family services shall use money Money in the Ohio's best Rx program fund shall be used to make payments to participating terminal distributors and the Ohio's best Rx program administrator under section 5110.17 5110.23 of the Revised Code and to make transfers to the Ohio's best Rx administration fund in accordance with section 5110.43 of the Revised Code.
Sec. 5110.33 5110.43 (A) The Ohio's best Rx administration fund is hereby created in the state treasury. The treasurer of state shall transfer from the Ohio's best Rx program fund to the Ohio's best Rx administration fund amounts equal to the following:
(1) Amounts resulting from application of the rebate program administration percentage, if a program administration percentage is determined by the department of job and family services in rules adopted under section 5110.354 5110.35 of the Revised Code;
(2) The amount of the administrative fees charged Ohio's best Rx participants, if an administrative fee is determined by the department of job and family services in rules adopted under section 5110.35 of the Revised Code;
(3) The amount of any donations credited to the Ohio's best Rx program fund;
(4) The amount of investment earnings credited to the Ohio's best Rx program fund.
The treasurer of state shall make the transfers in accordance with a schedule developed by the treasurer of state and the department of job and family services.
(B) The department of job and family services shall use money in the Ohio's best Rx administration fund to pay the administrative costs of the Ohio's best Rx program, including, but not limited to, costs associated with contracted services, staff, outreach activities, computers and network services, and the Ohio's best Rx program council. If the fund includes an amount that exceeds the amount necessary to pay the administrative costs of the program, the department may use the excess amount to pay the cost of subsidies provided to Ohio's best Rx program participants under any subsidy program established pursuant to section 5110.39 of the Revised Code.
Sec. 5110.23 5110.54(A) The department of job and family services shall compile both of the following lists regarding the Ohio's best Rx program:
(1) A list consisting of the name of each drug manufacturer that enters into a rebate manufacturer agreement under section 5110.21 of the Revised Code and the names of the drugs included in each rebate manufacturer agreement;
(2) A list consisting of the name of each participating terminal distributor and the name of the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code.
(B) As part of the list compiled under division (A)(1) of this section, the department may include aggregate information regarding the drugs selected under section 5110.30 of the Revised Code that were verified under that section as having per unit manufacturer payment amounts that were not more than two per cent lower than the per unit payment amounts negotiated for the same drugs by the program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code. The information shall not identify a specific drug and shall be expressed only as a percentage of the sample of drugs selected under section 5110.30 of the Revised Code.
(C) The lists compiled under this section are public records for the purpose of section 149.43 of the Revised Code. The department shall specifically make the lists available to physicians, participating terminal distributors, and other health professionals.
Sec. 5110.55.  Information transmitted by or to any of the following for any purpose related to the Ohio's best Rx program is confidential to the extent required by federal and state law:
(A) Drug manufacturers;
(B) Terminal distributors of dangerous drugs;
(C) The Ohio's best Rx program administrator;
(D) The department of job and family services;
(E) The department of administrative services;
(F) The state retirement systems;
(G) A state health benefit plan or state retirement system health benefit plan;
(H)(D) The program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code;
(E) Ohio's best Rx program participants;
(I)(F) Any other government entity or person.
Sec. 5110.56.  (A) Except as provided by section 5110.57 of the Revised Code, all of the following are trade secrets, are not public records for the purposes of section 149.43 of the Revised Code, and shall not be used, released, published, or disclosed in a form that reveals a specific drug or the identity of a drug manufacturer:
(1) The amounts determined under section 5110.17 5110.23 of the Revised Code for payment of claims submitted by participating terminal distributors and the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 of the Revised Code;
(2) Information disclosed in a rebate manufacturer agreement entered into under section 5110.26 of the Revised Code or in communications related to a rebate an agreement;
(3) Information that the department of administrative services and state retirement systems submit to the department of job and family services under divisions (A)(3) and (4) of section 5110.25 of the Revised Code Drug pricing and drug manufacturer payment information verified under sections 5110.09 and 5110.30 of the Revised Code by the program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code;
(4) Information contained in or pertaining to an audit provided for by the program's consulting pharmacy benefit manager under section 5110.05 of the Revised Code;
(5) The elements of the computations under division (C) of section 5110.21 of the Revised Code and under section 5110.27 made pursuant to sections 5110.10, 5110.23, and 5110.28 of the Revised Code and any results of those computations that reveal or could be used to reveal the drug pricing or rebate information and manufacturer payment amounts used to make the computations.
(B) No person or government entity shall use or reveal any information specified in division (A) of this section except as required for the implementation of this chapter.
Sec. 5110.57.  Sections 5110.55 and 5110.56 of the Revised Code shall not preclude the department of job and family services from disclosing information necessary for the implementation of this chapter, including the amount an Ohio's best Rx program price participant is to participating terminal distributors or the Ohio's best Rx program administrator be charged when the amount is disclosed under section 5110.29 5110.11 of the Revised Code to participating terminal distributors or the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code.
Sec. 5110.58. (A) As used in this section, "identifying information" means information that identifies or could be used to identify an Ohio's best Rx program applicant or participant. "Identifying information" does not include aggregate information about applicants and participants that does not identify and could not be used to identify an individual applicant or participant.
(B) Except as provided in divisions (C), (D), and (E) of this section, no person or government entity shall sell, solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information.
(C)(1) The department of job and family services and the Ohio's best Rx program administrator may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information for a purpose directly connected to the administration of the Ohio's best Rx program, including disclosing and knowingly permitting the use of identifying information included in a claim that a participating manufacturer audits pursuant to division (D) of section 5110.21 5110.32 of the Revised Code, contacting Ohio's best Rx program applicants or participants regarding participation in the program, and notifying applicants and participants regarding participating terminal distributors and the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code.
(2) The department and administrator may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required by federal law.
(3) The department and administrator may disclose identifying information to the Ohio's best Rx program applicant or participant who is the subject of that information or to the parent, spouse, guardian, or custodian of that applicant or participant.
(D)(1) A participating terminal distributor or the Ohio's best Rx program administrator may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required or permitted by an agreement the distributor enters into under section 5110.12 5110.20 of the Revised Code or a contract the administrator enters into under section 5110.10 of the Revised Code.
(2) Subject to division (B) of section 5110.19 of the Revised Code, the drug mail order system included in the program pursuant to section 5110.19 of the Revised Code may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required or permitted by the department.
(E) A participating manufacturer may, for the purpose of auditing a claim pursuant to division (D) of section 5110.21 5110.32 of the Revised Code, solicit, receive, and use identifying information included in the claim.
Sec. 5110.59. The (A) Except as provided in division (B) of this section, the department of job and family services and the Ohio's best Rx program administrator shall use and preserve records regarding the Ohio's best Rx program in accordance with rules adopted under section 5110.35 of the Revised Code. This section applies to the department's or administrator's use and preservation of The department shall use and preserve the records in accordance with those rules, regardless of whether the department generated the records or received or generated by the department, any other them from another government entity, or any person.
(B) All records received by the department under sections 5110.09 and 5110.30 of the Revised Code from the program's consulting pharmacy benefit manager selected under section 5110.04 of the Revised Code shall be destroyed promptly after the department has completed the purpose for which the information contained in the records was obtained.
Section 2. That existing sections 127.16, 2921.13, 5110.01, 5110.02, 5110.05, 5110.07, 5110.08, 5110.09, 5110.12, 5110.13, 5110.16, 5110.17, 5110.18, 5110.19, 5110.21, 5110.23, 5110.29, 5110.32, 5110.33, 5110.35, 5110.352, 5110.353, 5110.354, 5110.38, 5110.39, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59 and sections 5110.03, 5110.10, 5110.11, 5110.14, 5110.15, 5110.22, 5110.25, 5110.26, 5110.27, 5110.28, and 5110.351 of the Revised Code are hereby repealed.
Section 3. All duties and any other obligations of the Department of Administrative Services, Public Employees Retirement System, State Teachers Retirement System, School Employees Retirement System, Ohio Police and Fire Pension Fund, and State Highway Patrol Retirement System pertaining to the Ohio's Best Rx Program, as specified in Chapter 5110. of the Revised Code as it existed prior to the effective date of Sections 1 and 2 of this act, are hereby eliminated.
Section 4. That sections 127.16, 173.06, 173.062, 173.99, 2921.13, 5110.01, 5110.02, 5110.021, 5110.03, 5110.04, 5110.05, 5110.07, 5110.08, 5110.09, 5110.10, 5110.11, 5110.12, 5110.13, 5110.14, 5110.15, 5110.16, 5110.17, 5110.18, 5110.19, 5110.20, 5110.21, 5110.22, 5110.23, 5110.24, 5110.25, 5110.26, 5110.27, 5110.28, 5110.29, 5110.30, 5110.31, 5110.32, 5110.35, 5110.352, 5110.353, 5110.354, 5110.36, 5110.37, 5110.38, 5110.39, 5110.40, 5110.42, 5110.43, 5110.45, 5110.47, 5110.54, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59 be amended and sections 173.062 (173.061), 5110.01 (173.71), 5110.02 (173.72), 5110.021 (173.721), 5110.03 (173.73), 5110.04 (173.731), 5110.05 (173.732), 5110.07 (173.74), 5110.08 (173.741), 5110.09 (173.742), 5110.10 (173.75), 5110.11 (173.751), 5110.12 (173.752), 5110.13 (173.753), 5110.14 (173.76), 5110.15 (173.77), 5110.16 (173.771), 5110.17 (173.772), 5110.18 (173.773), 5110.19 (173.78), 5110.20 (173.79), 5110.21 (173.791), 5110.22 (173.80), 5110.23 (173.801), 5110.24 (173.802), 5110.25 (173.803), 5110.26 (173.81), 5110.27 (173.811), 5110.28 (173.812), 5110.29 (173.813), 5110.30 (173.814), 5110.31 (173.815), 5110.32 (173.82), 5110.35 (173.83), 5110.352 (173.831), 5110.353 (173.832), 5110.354 (173.833), 5110.36 (173.84), 5110.37 (173.722), 5110.38 (173.724), 5110.39 (173.861), 5110.40 (173.723), 5110.42 (173.85), 5110.43 (173.86), 5110.45 (173.87), 5110.46 (173.871), 5110.47 (173.872), 5110.48 (173.873), 5110.49 (173.874), 5110.50 (173.875), 5110.51 (173.876), 5110.54 (173.88), 5110.55 (173.89), 5110.56 (173.891), 5110.57 (173.892), 5110.58 (173.90), and 5110.59 (173.91) of the Revised Code be amended for the purpose of adopting new section numbers as indicated in parentheses to read as follows:
Sec. 127.16.  (A) Upon the request of either a state agency or the director of budget and management and after the controlling board determines that an emergency or a sufficient economic reason exists, the controlling board may approve the making of a purchase without competitive selection as provided in division (B) of this section.
(B) Except as otherwise provided in this section, no state agency, using money that has been appropriated to it directly, shall:
(1) Make any purchase from a particular supplier, that would amount to fifty thousand dollars or more when combined with both the amount of all disbursements to the supplier during the fiscal year for purchases made by the agency and the amount of all outstanding encumbrances for purchases made by the agency from the supplier, unless the purchase is made by competitive selection or with the approval of the controlling board;
(2) Lease real estate from a particular supplier, if the lease would amount to seventy-five thousand dollars or more when combined with both the amount of all disbursements to the supplier during the fiscal year for real estate leases made by the agency and the amount of all outstanding encumbrances for real estate leases made by the agency from the supplier, unless the lease is made by competitive selection or with the approval of the controlling board.
(C) Any person who authorizes a purchase in violation of division (B) of this section shall be liable to the state for any state funds spent on the purchase, and the attorney general shall collect the amount from the person.
(D) Nothing in division (B) of this section shall be construed as:
(1) A limitation upon the authority of the director of transportation as granted in sections 5501.17, 5517.02, and 5525.14 of the Revised Code;
(2) Applying to medicaid provider agreements under Chapter 5111. of the Revised Code or payments or provider agreements under the disability medical assistance program established under Chapter 5115. of the Revised Code;
(3) Applying to the purchase of examinations from a sole supplier by a state licensing board under Title XLVII of the Revised Code;
(4) Applying to entertainment contracts for the Ohio state fair entered into by the Ohio expositions commission, provided that the controlling board has given its approval to the commission to enter into such contracts and has approved a total budget amount for such contracts as agreed upon by commission action, and that the commission causes to be kept itemized records of the amounts of money spent under each contract and annually files those records with the clerk of the house of representatives and the clerk of the senate following the close of the fair;
(5) Limiting the authority of the chief of the division of mineral resources management to contract for reclamation work with an operator mining adjacent land as provided in section 1513.27 of the Revised Code;
(6) Applying to investment transactions and procedures of any state agency, except that the agency shall file with the board the name of any person with whom the agency contracts to make, broker, service, or otherwise manage its investments, as well as the commission, rate, or schedule of charges of such person with respect to any investment transactions to be undertaken on behalf of the agency. The filing shall be in a form and at such times as the board considers appropriate.
(7) Applying to purchases made with money for the per cent for arts program established by section 3379.10 of the Revised Code;
(8) Applying to purchases made by the rehabilitation services commission of services, or supplies, that are provided to persons with disabilities, or to purchases made by the commission in connection with the eligibility determinations it makes for applicants of programs administered by the social security administration;
(9) Applying to payments by the department of job and family services under section 5111.13 of the Revised Code for group health plan premiums, deductibles, coinsurance, and other cost-sharing expenses;
(10) Applying to any agency of the legislative branch of the state government;
(11) Applying to agreements or contracts entered into under section 5101.11, 5101.20, 5101.201, 5101.21, or 5101.214 of the Revised Code;
(12) Applying to purchases of services by the adult parole authority under section 2967.14 of the Revised Code or by the department of youth services under section 5139.08 of the Revised Code;
(13) Applying to dues or fees paid for membership in an organization or association;
(14) Applying to purchases of utility services pursuant to section 9.30 of the Revised Code;
(15) Applying to purchases made in accordance with rules adopted by the department of administrative services of motor vehicle, aviation, or watercraft fuel, or emergency repairs of such vehicles;
(16) Applying to purchases of tickets for passenger air transportation;
(17) Applying to purchases necessary to provide public notifications required by law or to provide notifications of job openings;
(18) Applying to the judicial branch of state government;
(19) Applying to purchases of liquor for resale by the division of liquor control;
(20) Applying to purchases of motor courier and freight services made in accordance with department of administrative services rules;
(21) Applying to purchases from the United States postal service and purchases of stamps and postal meter replenishment from vendors at rates established by the United States postal service;
(22) Applying to purchases of books, periodicals, pamphlets, newspapers, maintenance subscriptions, and other published materials;
(23) Applying to purchases from other state agencies, including state-assisted institutions of higher education;
(24) Limiting the authority of the director of environmental protection to enter into contracts under division (D) of section 3745.14 of the Revised Code to conduct compliance reviews, as defined in division (A) of that section;
(25) Applying to purchases from a qualified nonprofit agency pursuant to sections 125.60 to 125.6012 or 4115.31 to 4115.35 of the Revised Code;
(26) Applying to payments by the department of job and family services to the United States department of health and human services for printing and mailing notices pertaining to the tax refund offset program of the internal revenue service of the United States department of the treasury;
(27) Applying to contracts entered into by the department of mental retardation and developmental disabilities under sections 5123.18, 5123.182, and 5123.199 of the Revised Code;
(28) Applying to payments made by the department of mental health under a physician recruitment program authorized by section 5119.101 of the Revised Code;
(29) Applying to contracts entered into with persons by the director of commerce for unclaimed funds collection and remittance efforts as provided in division (F) of section 169.03 of the Revised Code. The director shall keep an itemized accounting of unclaimed funds collected by those persons and amounts paid to them for their services.
(30) Applying to purchases made by a state institution of higher education in accordance with the terms of a contract between the vendor and an inter-university purchasing group comprised of purchasing officers of state institutions of higher education;
(31) Applying to the department of job and family services' purchases of health assistance services under the children's health insurance program part I provided for under section 5101.50 of the Revised Code or the children's health insurance program part II provided for under section 5101.51 of the Revised Code;
(32) Applying to payments by the attorney general from the reparations fund to hospitals and other emergency medical facilities for performing medical examinations to collect physical evidence pursuant to section 2907.28 of the Revised Code;
(33) Applying to contracts with a contracting authority or administrative receiver under division (B) of section 5126.056 of the Revised Code;
(34) Applying to reimbursements paid to the United States department of veterans affairs for pharmaceutical and patient supply purchases made on behalf of the Ohio veterans' home agency;
(35) Applying to agreements entered into with terminal distributors of dangerous drugs under section 5110.20 173.79 of the Revised Code.
(E) Notwithstanding division (B)(1) of this section, the cumulative purchase threshold shall be seventy-five thousand dollars for the departments of mental retardation and developmental disabilities, mental health, rehabilitation and correction, and youth services.
(F) When determining whether a state agency has reached the cumulative purchase thresholds established in divisions (B)(1), (B)(2), and (E) of this section, all of the following purchases by such agency shall not be considered:
(1) Purchases made through competitive selection or with controlling board approval;
(2) Purchases listed in division (D) of this section;
(3) For the purposes of the thresholds of divisions (B)(1) and (E) of this section only, leases of real estate.
(G) As used in this section, "competitive selection," "purchase," "supplies," and "services" have the same meanings as in section 125.01 of the Revised Code.
Sec. 173.06.  (A) The director of aging shall establish a golden buckeye card program and provide a golden buckeye card to any resident of this state who applies to the director for a card and is sixty years of age or older or is a person with a disability and is eighteen years of age or older. The director shall devise programs to provide benefits of any kind to card holders, and encourage support and participation in them by all persons, including governmental organizations. Card holders shall be entitled to any benefits granted to them by private persons or organizations, the laws of this state, or ordinances or resolutions of political subdivisions. This section does not require any person or organization to provide benefits to any card holder. The department of aging shall bear all costs of the program, except that the department is not required to bear any costs related to the prescription drug programs established pursuant to section 173.061 of the Revised Code.
(B) Before issuing a golden buckeye card to any person, the director shall establish the identity of any person who applies for a card and shall ascertain that such person is sixty years of age or older or is a person with a disability and is eighteen years of age or older. The director shall adopt rules under Chapter 119. of the Revised Code to prevent the issuance of cards to persons not qualified to have them. Cards shall contain the signature of the card holder and any other information the director considers necessary to carry out the purposes of the golden buckeye card program under this section. Any card that the director issues shall be held in perpetuity by the original card holder and shall not be transferable to any other person. A person who loses the person's card may obtain another card from the director upon providing the same information to the director as was required for the issuance of the original card.
(C) No person shall use a golden buckeye card except to obtain a benefit for the holder of the card to which the holder is entitled under the conditions of the offer.
(D) As used in this section, "person with a disability" means a person who has some impairment of body or mind and has been certified as permanently and totally disabled by an agency of this state or the United States having the function of so classifying persons.
Sec. 173.062 173.061Records identifying the recipients of golden buckeye cards issued under section 173.06 of the Revised Code or prescription drug cards issued under section 173.061 of the Revised Code are not public records subject to inspection or copying under section 149.43 of the Revised Code and may be disclosed only at the discretion of the director of aging. The director may disclose only information in records identifying the recipients of golden buckeye cards or prescription drug cards that does not contain the recipient's medical history or prescription drug utilization history.
Sec. 5110.01 173.71 As used in this chapter sections 173.71 to 173.91 of the Revised Code:
(A) "Children's health insurance program" means the children's health insurance program part I and part II established under sections 5101.50 to 5101.5110 of the Revised Code.
(B) "Disability medical assistance program" means the program established under section 5115.10 of the Revised Code.
(C) "Medicaid program" or "medicaid" means the medical assistance program established under Chapter 5111. of the Revised Code.
(D) "National drug code number" means the number registered for a drug pursuant to the listing system established by the United States food and drug administration under the "Drug Listing Act of 1972," 86 Stat. 559, 21 U.S.C. 360, as amended.
(E) "Ohio's best Rx program participant" or "participant" means an individual determined eligible for the Ohio's best Rx program and included under an Ohio's best Rx program enrollment card.
(F) "Participating manufacturer" means a drug manufacturer participating in the Ohio's best Rx program pursuant to a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code.
(G) "Participating terminal distributor" means a terminal distributor of dangerous drugs participating in the Ohio's best Rx program pursuant to an agreement entered into under section 5110.20 173.79 of the Revised Code.
(H) "Political subdivision" has the same meaning as in section 9.23 of the Revised Code.
(I) "State agency" has the same meaning as in section 9.23 of the Revised Code.
(J) "Terminal distributor of dangerous drugs" has the same meaning as in section 4729.01 of the Revised Code.
(K) "Third-party payer" has the same meaning as in section 3901.38 of the Revised Code.
(L) "Trade secret" has the same meaning as in section 1333.61 of the Revised Code.
(M) "Usual and customary charge" means the amount a participating terminal distributor or the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code charges when a drug included in the program is purchased by an individual who does not receive a discounted price for the drug pursuant to any drug discount program, including the Ohio's best Rx program, a prescription drug discount card program established under section 173.061 of the Revised Code, or a pharmacy assistance program established by any person or government entity, and for whom no third-party payer or program funded in whole or part with state or federal funds is responsible for all or part of the cost of the drug.
Sec. 5110.02 173.72There is hereby established the Ohio's best Rx program for the purpose of providing outpatient prescription drug discounts to individuals residing in this state who are enrolled in the program by meeting the eligibility requirements specified in section 5110.14 173.76 of the Revised Code, including eligible individuals who are sixty years of age or older, eligible individuals who have low incomes but are not eligible for medicaid, and other eligible individuals who do not have health benefits that cover outpatient drugs. The program shall include all drugs that are included in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code and all other drugs that may be dispensed only pursuant to a prescription issued by a licensed health professional authorized to prescribe drugs, as defined in section 4729.01 of the Revised Code.
Sec. 5110.021 173.721(A) Except as provided in division (B) of this section, the Ohio's best Rx program shall be administered by the department of job and family services aging.
(B)(1) The department may enter into a contract with any person under which the person serves as the administrator of the Ohio's best Rx program. Before entering into a contract for a program administrator, the department shall issue a request for proposals from persons seeking to be considered. The department shall develop a process to be used in issuing the request for proposals, receiving responses to the request, and evaluating the responses on a competitive basis. In accordance with that process, the department shall select the person to be awarded the contract.
(2) Subject to divisions (B)(5) and (6) of this section, the department may delegate to the person awarded the contract any of the department's powers or duties specified in this chapter sections 173.71 to 173.91 of the Revised Code or any other provision of the Revised Code pertaining to the Ohio's best Rx program. The terms of the contract shall specify the extent to which the powers or duties are delegated to the program administrator.
(3) In exercising powers or performing duties delegated under the contract, the program administrator is subject to the same provisions of this chapter sections 173.71 to 173.91 of the Revised Code or other provisions of the Revised Code that grant the powers or duties to the department, as well as any limitations or restrictions that are applicable to or associated with those powers or duties.
(4) Wherever the department is referred to in this chapter sections 173.71 to 173.91 of the Revised Code or another provision of the Revised Code relative to a power or duty delegated to the program administrator, both of the following apply:
(a) If the department has delegated the power or duty in whole to the program administrator, the reference to the department is, instead, a reference to the administrator.
(b) If the department retains any part of the power or duty that is delegated to the program administrator, the reference to the department is a reference to both the department and the administrator.
(5) The terms of a contract for a program administrator shall include provisions for offering the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code. The terms of the contract may permit the administrator to offer the drug mail order system by contracting with another person.
(6) The department shall not delegate to a program administrator the department's powers or duties to do any of the following:
(a) Enter into contracts under this section other than a contract to offer a drug mail order system;
(b) Receive verification of drug pricing information under section 5110.09 173.742 of the Revised Code or verification of drug manufacturer payment information under section 5110.30 173.814 of the Revised Code from the pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code to serve as the Ohio's best Rx program's consulting pharmacy benefit manager;
(c) Request the program's consulting pharmacy benefit manager to provide for an audit under section 5110.05 173.732 of the Revised Code;
(d) Review or use any information contained in or pertaining to an audit provided for by the program's consulting pharmacy benefit manager other than the audit's findings of whether the consulting pharmacy benefit manager provided valid information when providing drug pricing verification services or drug manufacturer payment verification services;
(e) Adopt rules under section 5110.35 173.83 or 5110.36 173.84 of the Revised Code;
(f) Employ an ombudsperson pursuant to section 5110.40 173.723 of the Revised Code.
Sec. 5110.37 173.722 The department of job and family services aging shall undertake outreach efforts to publicize the Ohio's best Rx program and maximize participation in the program.
Sec. 5110.40 173.723The department of job and family services aging shall employ an ombudsperson to assist terminal distributors of dangerous drugs with grievances regarding the Ohio's best Rx program.
Sec. 5110.38 173.724 The department of job and family services aging may coordinate the Ohio's best Rx program with any either of the following:
(A) The golden buckeye card program established under section 173.06 of the Revised Code. In coordinating the programs, the department may establish a card that serves as both a golden buckeye card provided under section 173.06 of the Revised Code and an Ohio's best Rx program enrollment card issued under section 173.773 of the Revised Code. The department may identify the card by including the names of both programs on the card or by selecting a combined name for inclusion on the card.
(B) Any health benefit plan offered to the employees of state agencies and the eligible dependents of those employees, for purposes of enhancing efficiency, reducing the cost of drugs, and maximizing the benefits of the Ohio's best Rx program and the health benefit plan.
Sec. 5110.03 173.73(A) Any entity that provides services as a pharmacy benefit manager relative to the outpatient drug coverage included in a health benefit plan offered to the employees or retirees of a state agency or political subdivision and the eligible dependents of those employees or retirees shall provide drug pricing verification services under section 5110.09 173.742 of the Revised Code and drug manufacturer payment verification services under section 5110.30 173.814 of the Revised Code if the entity is selected under section 5110.04 173.731 of the Revised Code by the department of job and family services aging to serve as the Ohio's best Rx program's consulting pharmacy benefit manager for purposes of providing the verification services.
(B) Both of the following apply to the entity selected to serve as the Ohio's best Rx program's consulting pharmacy benefit manager:
(1) The entity shall provide the drug pricing verification services and drug manufacturer payment verification services without charge, either to the Ohio's best Rx program or to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.
(2) The entity shall provide the verification services for the entire year for which it is selected to serve as the program's consulting pharmacy benefit manager, regardless of the duration or termination of its responsibility to the state agency or political subdivision for which it provides services as a pharmacy benefit manager.
(C) If the entity selected to serve as the consulting pharmacy benefit manager fails to provide the program with drug pricing verification services or drug manufacturer payment verification services, or fails to provide for an audit when requested to do so under section 5110.05 173.732 of the Revised Code, the department may ask the attorney general to bring an action for injunctive relief in any court of competent jurisdiction. On the filing of an appropriate petition in the court, the court shall conduct a hearing on the petition. If it is demonstrated in the proceedings that the pharmacy benefit manager has failed to provide the verification services or has failed to provide for the audit, the court shall grant a temporary or permanent injunction enjoining the pharmacy benefit manager from continuing to fail to provide the verification services or from continuing to fail to provide for the audit.
(D) This section does not impose any duty on the state agency or political subdivision for which an entity provides services as a pharmacy benefit manager.
Sec. 5110.04 173.731Annually, the department of job and family services aging shall select a pharmacy benefit manager, from among the pharmacy benefit managers subject to section 5110.03 173.73 of the Revised Code, to serve as the Ohio's best Rx program's consulting pharmacy benefit manager for purposes of providing drug pricing verification services under section 5110.09 173.742 of the Revised Code and drug manufacturer payment verification services under section 5110.30 173.814 of the Revised Code. The department shall select the pharmacy benefit manager that the department considers to be the most appropriate pharmacy benefit manager to provide the verification services for the Ohio's best Rx program. In making the selection, the department shall consider the pharmacy benefit manager that provides services relative to the outpatient drug coverage included in the health benefit plan offered to the greatest number of employees or retirees of a state agency or political subdivision and the eligible dependents of those employees or retirees.
The department shall provide written notice to the pharmacy benefit manager that it has been selected to serve as the Ohio's best Rx program's consulting pharmacy benefit manager. The notice shall specify the date on which the pharmacy benefit manager is to begin serving as the program's consulting pharmacy benefit manager for the ensuing year.
Before the end of the one-year period during which a pharmacy benefit manager is to serve as the program's consulting pharmacy benefit manager, the department shall make another selection in accordance with this section. In making the selection, the department may select the same pharmacy benefit manager to serve as the program's consulting pharmacy benefit manager or may select another pharmacy benefit manager.
Sec. 5110.05 173.732(A) To determine whether the pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code to serve as the Ohio's best Rx program's consulting pharmacy benefit manager has provided valid information when providing drug pricing verification services under section 5110.09 173.742 of the Revised Code or drug manufacturer payment verification services under section 5110.30 173.814 of the Revised Code, the department of job and family services aging may request that the consulting pharmacy benefit manager provide for an audit of its relevant contracts with drug manufacturers and terminal distributors of dangerous drugs.
In making audit requests under this section, both of the following apply:
(1) The department may request an audit on a regularly occurring basis, but not more frequently than once every three years.
(2) The department may request an audit at any time it has a reasonable basis to believe that the consulting pharmacy benefit manager is not acting in good faith in providing drug pricing verification services or drug manufacturer payment verification services. Notice of the request shall be made in writing and signed by the director of job and family services aging. The notice may specify the basis for the belief that the consulting pharmacy benefit manager is not acting in good faith. If the basis for the belief is not specified and the audit findings demonstrate that the consulting pharmacy benefit manager acted in good faith, the department shall pay the cost incurred by the consulting pharmacy benefit manager in providing for the audit.
(B) An audit provided for under this section shall be performed only by an auditor that is mutually satisfactory to the department and consulting pharmacy benefit manager and independent of both the department and consulting pharmacy benefit manager.
(C) If the findings of an audit provided for under this section demonstrate that the verification services provided by the consulting pharmacy benefit manager did not result in valid information, the department shall use the audit findings for purposes of confirming the validity of the one or more drug pricing formulas designated under section 5110.08 173.741 of the Revised Code and entering into agreements with drug manufacturers under section 5110.26 173.81 of the Revised Code.
Sec. 5110.07 173.74Annually, the department of job and family services aging shall establish a base price for each drug included in the Ohio's best Rx program. In the case of drugs dispensed by a terminal distributor of dangerous drugs that has entered into an agreement under section 5110.20 173.79 of the Revised Code, the base price shall be established by using the one or more formulas designated under section 5110.08 173.741 of the Revised Code. In the case of the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code, the base price shall be established in accordance with the rules adopted under section 5110.35 173.83 of the Revised Code governing the drug mail order system.
Sec. 5110.08 173.741Annually, the department of job and family services aging shall designate one or more formulas for use in establishing under section 5110.07 173.74 of the Revised Code the Ohio's best Rx program's base price for drugs dispensed by a terminal distributor of dangerous drugs that has entered into an agreement under section 5110.20 173.79 of the Revised Code. Each formula shall include a drug pricing discount component that is expressed as a percentage discount. The formula used for generic drugs may include the maximum allowable cost limits that apply to generic drugs under the medicaid program.
In designating the one or more formulas, the department shall use the best information on drug pricing that is available to the department, including information obtained through the drug pricing verification services provided under section 5110.09 173.742 of the Revised Code by the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code. Based on the available information, the department shall modify the one or more formulas as it considers appropriate to maximize the benefits provided to Ohio's best Rx program participants.
Sec. 5110.09 173.742For purposes of section 5110.08 173.741 of the Revised Code, the department of job and family services aging shall obtain verification of drug pricing information from the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code. The information shall be obtained in accordance with the following procedures:
(A) For brand name drugs, excluding generic drugs marketed under brand names, the department shall submit to the consulting pharmacy benefit manager the formula the department proposes to use to establish the program's base price for brand name drugs during the year.
The consulting pharmacy benefit manager shall review the formula submitted by the department. In conducting the review, the consulting pharmacy benefit manager shall compare the drug pricing discount percentage included in the department's formula to the drug pricing discount percentage included in the formula most commonly used by the consulting pharmacy benefit manager to establish part of its payment rate for brand name drugs dispensed by terminal distributors of dangerous drugs other than drug mail order systems. If the formulas are not expressed in equivalent terms, the consulting pharmacy benefit manager shall make all accommodations necessary to make the comparison of the discount percentages.
After conducting the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether the discount percentage included in the department's formula is more than two percentage points below the discount percentage included in the formula used by the consulting pharmacy benefit manager. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
(B) For generic drugs, the department shall identify the fifty generic drugs most frequently purchased by Ohio's best Rx program participants in the immediately preceding year from terminal distributors of dangerous drugs other than the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code. The department shall submit to the consulting pharmacy benefit manager the names of the fifty drugs, the number of prescriptions filled for each of the drugs, the formula used to compute the base price for the drugs during the year, and the weighted average base price for the drugs that resulted for the year.
The consulting pharmacy benefit manager shall review the submitted information. In conducting the review, the consulting pharmacy benefit manager shall compare the department's weighted average base price to the equivalent part of the consulting pharmacy benefit manager's weighted average payment rate for the same drugs when dispensed by terminal distributors of dangerous drugs other than drug mail order systems. For purposes of the comparison, the department and consulting pharmacy benefit manager shall express the weighted average base price and payment rate in terms of a discount percentage that is taken from the drugs' average wholesale price, as identified by a national drug price reporting service selected by the department and the consulting pharmacy benefit manager.
After conducting the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether the discount percentage reflected in the department's weighted average base price for the drugs is more than two percentage points below the equivalent part of the consulting pharmacy benefit manager's weighted average payment rate for the same drugs. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
Sec. 5110.10 173.75(A) Subject to division (B) of this section, the amount that an Ohio's best Rx program participant is to be charged for a quantity of a drug purchased under the program shall be established in accordance with all of the following:
(1) If the drug is not included in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code, the participant shall be charged an amount that is computed according to the drug's base price established under section 5110.07 173.74 of the Revised Code.
(2) If the drug is included in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code, the participant shall be charged an amount that is computed by subtracting from the drug's base price established under section 5110.07 173.74 of the Revised Code the amount of the manufacturer payment that applies to the transaction, as established under section 5110.28 173.812 of the Revised Code.
(3) If an administrative fee is specified in rules adopted under section 5110.35 173.83 of the Revised Code, the participant shall be charged the amount of the administrative fee.
(4) If the drug is dispensed by a terminal distributor of dangerous drugs under an agreement entered into under section 5110.20 173.79 of the Revised Code, and the terminal distributor charges a professional fee pursuant to the agreement, the participant shall be charged the amount of the professional fee.
(5) If the drug is dispensed through the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code, the participant shall not be charged a professional fee.
(B) When a quantity of a drug is purchased by an Ohio's best Rx program participant, the participating terminal distributor or drug mail order system dispensing the drug shall charge the lesser of the amount that applies to the transaction, as established in accordance with division (A) of this section, or the usual and customary charge that otherwise would apply to the transaction. When a drug is purchased at the usual and customary charge pursuant to this division, the transaction is not subject to this chapter sections 173.71 to 173.91 of the Revised Code as the purchase or dispensing of a drug under the program.
Sec.  5110.11 173.751 The department of job and family services aging shall report the following to each participating terminal distributor and the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code in a manner enabling the distributor and system to comply with section 5110.10 173.75 of the Revised Code:
(A) For each drug included in the program, the amount to be charged under division (A)(1) or (2) of section 5110.10 173.75 of the Revised Code;
(B) The administrative fee, if any, specified by the department in rules adopted under section 5110.35 173.83 of the Revised Code.
Sec. 5110.12 173.752The amount that an Ohio's best Rx program participant saves when a drug is purchased under the program shall be determined by subtracting the amount that the participant is charged in accordance with division (A) of section 5110.10 173.75 of the Revised Code from the usual and customary charge that otherwise would apply to the transaction.
Sec.  5110.13 173.753 Not later than the first day of March of each year, the department of job and family services aging shall do all of the following:
(A) Create a list of the twenty-five drugs most often dispensed to Ohio's best Rx program participants under the program, using data from the most recent six-month period for which the data is available;
(B) Determine the average amount that participants are charged under the program, on a date selected by the department, for each drug included on the list created under division (A) of this section;
(C) Determine, for the date selected for division (B) of this section, the average usual and customary charge for each drug included on the list created under division (A) of this section;
(D) By comparing the average charges determined under divisions (B) and (C) of this section, determine the average percentage savings Ohio's best Rx program participants receive for each drug included on the list created under division (A) of this section.
Sec.  5110.14 173.76(A) To be eligible for the Ohio's best Rx program, an individual must meet all of the following requirements at the time of application for the program:
(1) The individual must be a resident of this state.
(2) Either One of the following must be the case:
(a) The individual has family income, as determined under rules adopted pursuant to section 5110.35 173.83 of the Revised Code, that does not exceed three hundred per cent of the federal poverty guidelines, as revised annually by the United States department of health and human services in accordance with section 673(2) of the "Omnibus Budget Reconciliation Act of 1981," 95 Stat. 511, 42 U.S.C. 9902, as amended;
(b) The individual is sixty years of age or older;
(c) The individual is a disabled person, as defined in section 173.06 of the Revised Code.
(3) Except as provided in division (B) of this section, the individual must not have coverage for outpatient drugs paid for in whole or in part by any of the following:
(a) A third-party payer, including an employer;
(b) The medicaid program;
(c) The children's health insurance program;
(d) The disability medical assistance program;
(e) Another health plan or pharmacy assistance program that uses state or federal funds to pay part or all of the cost of the individual's outpatient drugs.
(4) The individual must not have had coverage for outpatient drugs paid for by any of the entities or programs specified in division (A)(3) of this section during any of the four months preceding the month in which the application for the Ohio's best Rx program is made, unless any of the following applies:
(a) The individual is sixty years of age or older.
(b) The third-party payer, including an employer, that paid for the coverage filed for bankruptcy under federal bankruptcy laws.
(c) The individual is no longer eligible for coverage provided through a retirement plan subject to protection under the "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C. 1001, as amended.
(d) The individual is no longer eligible for the medicaid program, children's health insurance program, or disability medical assistance program.
(e) The individual is either temporarily or permanently discharged from employment due to a business reorganization.
(B) An individual is not subject to division (A)(3) of this section if the individual has coverage for outpatient drugs paid for in whole or in part by any either of the following:
(1) A prescription drug discount card program established under section 173.061 of the Revised Code;
(2) The workers' compensation program;
(3)(2) A medicare prescription drug plan offered pursuant to the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003," 117 Stat. 2071, 42 U.S.C. 1395w-101, as amended, but only if all of the following are the case with respect to the particular drug being purchased through the Ohio's best Rx program:
(a) The individual is responsible for the full cost of the drug.
(b) The drug is not subject to a rebate from the manufacturer under the individual's medicare prescription drug plan.
(c) The manufacturer of the drug has agreed to the Ohio's best Rx program's inclusion of individuals who have coverage through a medicare prescription drug plan.
Sec. 5110.15 173.77Application for participation in the Ohio's best Rx program shall be made in accordance with rules adopted by the department of job and family services aging under section 5110.35 173.83 of the Revised Code. When applying for participation, an individual may include application for participation by the individual's spouse and children. An individual's guardian or custodian may apply on behalf of the individual.
When submitting an application, the applicant shall include the information and documentation specified in the department's rules as necessary to verify eligibility for the program. The application may be submitted on a paper form prescribed and supplied by the department or pursuant to any other application method the department makes available for the program, including methods that permit an individual to apply by telephone or through the internet.
An applicant shall attest that the information and documentation the applicant submits with an application is accurate to the best knowledge and belief of the applicant. In the case of a paper application form, the applicant's signature shall be used to certify that the applicant has attested to the accuracy of the information and documentation. In the case of other application methods, the application certification process specified in the department's rules shall be used to certify that the applicant has attested to the accuracy of the information and documentation.
The department shall inform each applicant that knowingly making a false statement in an application is falsification under section 2921.13 of the Revised Code, a misdemeanor of the first degree. In the case of a paper application form, the department shall provide the information by including on the form a statement printed in bold letters.
Sec.  5110.16 173.771 The department of job and family services aging shall provide each applicant for the Ohio's best Rx program information about the medicaid program in accordance with rules adopted under section 5110.35 173.83 of the Revised Code. The information shall include general eligibility requirements, application procedures, and benefits. The information shall also explain the ways in which the medicaid program's drug benefits are better than the Ohio's best Rx program.
Sec.  5110.17 173.772On receipt of applications, the department of job and family services aging shall make eligibility determinations for the Ohio's best Rx program in accordance with procedures established in rules adopted under section 5110.35 173.83 of the Revised Code.
An eligibility determination under this section may not be appealed under Chapter 119., section 5101.35, or any other provision of the Revised Code.
Sec.  5110.18 173.773(A) The department of job and family services aging shall issue Ohio's best Rx program enrollment cards to or on behalf of individuals determined eligible to participate. One enrollment card may cover each member of a family determined eligible to participate.
The department shall determine the information to be included on the card, including an identification number, and shall determine the card's size and format. If the department establishes an application method that permits individuals to apply through the internet, the department may issue the enrollment card by sending the applicant an electronic version of the card in a printable format.
(B) Each time a drug is purchased under the program, the entity dispensing the drug shall confirm whether the individual for whom the drug is dispensed is enrolled in the program. If the drug is being purchased from a participating terminal distributor rather than the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code, and the individual's enrollment card is available for presentation at the time of the purchase, the purchaser shall present the card to the participating terminal distributor as confirmation of the individual's enrollment in the program. If the drug is being purchased through the drug mail order system and the individual's program identification number is available, the purchaser shall present the identification number as confirmation of enrollment. Otherwise, the terminal distributor or mail order system shall confirm the individual's enrollment through the department. The department shall establish the methods to be used in confirming enrollment through the department, including confirmation by telephone, through the internet, or by any other electronic means.
(C) Purchasing a drug under the program by using an enrollment card or any other method shall serve as an attestation by the participant for whom the drug is dispensed that the participant meets the eligibility requirements specified in division (A)(3) of section 5110.14 173.76 of the Revised Code regarding not having coverage for outpatient drugs.
Sec. 5110.19 173.78(A) For purposes of making drugs included in the Ohio's best Rx program available to participants by mail, the department of job and family services aging shall include a drug mail order system within the program. Not more than one drug mail order system shall be included in the program. Subject to division (B) of this section, the program's drug mail order system shall be provided in accordance with rules adopted under section 5110.35 173.83 of the Revised Code.
(B) Neither the department nor the drug mail order system shall promote the purchase of drugs through the system by using information collected under the program regarding the drugs purchased by participants from participating terminal distributors. This division does not preclude the use of the information for purposes of limiting the amount that a participant may be charged for a quantity of a drug purchased through the drug mail order system to an amount that is not more than the amount that would be charged if the same quantity of the drug were purchased from a participating terminal distributor.
Sec.  5110.20 173.79 (A) For purposes of making drugs included in the Ohio's best Rx program available to participants from terminal distributors of dangerous drugs other than the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code, the department of job and family services aging shall enter into agreements under this section with terminal distributors of dangerous drugs. Any terminal distributor of dangerous drugs may enter into an agreement with the department to participate in the program pursuant to this section.
Before entering into an agreement with a terminal distributor, the department shall provide the terminal distributor with one of the following:
(1) A formula that allows the terminal distributor to calculate for each drug included in the program the amount to be charged under division (A)(1) or (2) of section 5110.10 173.75 of the Revised Code by participating terminal distributors.
(2) A statistically valid sampling of drug prices that includes the amount to be charged under division (A)(1) or (2) of section 5110.10 173.75 of the Revised Code by participating terminal distributors for not fewer than two brand name drugs and two generic drugs from each category of drugs included in the program.
(3) The current amount to be charged under division (A)(1) or (2) of section 5110.10 173.75 of the Revised Code by participating terminal distributors for each drug included in the program.
(B) An agreement entered into under this section shall do all of the following:
(1) Except as provided in division (B)(3) of this section, be in effect for not less than one year;
(2) Specify the dates that the agreement is to begin and end;
(3) Permit the terminal distributor to terminate the agreement before the date the agreement would otherwise end as specified pursuant to division (B)(2) of this section by providing the department notice of early termination at least thirty days before the effective date of the early termination;
(4) Require that the terminal distributor comply with section 5110.10 173.75 of the Revised Code when charging for a drug purchased under the program;
(5) Permit the terminal distributor to add to the amount to be charged under division (A)(1) or (2) of section 5110.10 173.75 of the Revised Code a professional fee in an amount not to exceed, except as provided in rules adopted under section 5110.35 173.83 of the Revised Code, three dollars;
(6) Require the terminal distributor to disclose to each participant the amount the participant saves under the program as determined in accordance with section 5110.12 173.752 of the Revised Code;
(7) Require the terminal distributor to submit a claim to the department under section 5110.22 173.80 of the Revised Code for each sale of a drug to a participant;
(8) Permit the terminal distributor to deliver drugs to Ohio's best Rx program participants by mail, but not by using a drug mail order system operated in the same manner as the system included in the program pursuant to section 5110.19 173.78 of the Revised Code.
Sec.  5110.21 173.791 A terminal distributor of dangerous drugs shall not be prohibited from participating in any program or any network of health care providers on the basis that the terminal distributor has not entered into an agreement under section 5110.20 173.79 of the Revised Code to participate in the Ohio's best Rx program.
Sec.  5110.22 173.80 For each drug dispensed under the Ohio's best Rx program, a claim shall be submitted to the department of job and family services aging. The participating terminal distributor or the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code that dispensed the drug shall submit the claim not later than thirty days after the drug is dispensed. The claim shall be submitted in accordance with the electronic method provided for in rules adopted under section 5110.35 173.83 of the Revised Code.
The claim shall specify all of the following:
(A) The prescription number of the participant's prescription under which the drug was dispensed to the participant;
(B) The name of, and national drug code number for, the drug dispensed to the participant;
(C) The number of units of the drug dispensed to the participant;
(D) The amount the participant was charged for the drug;
(E) The date the drug was dispensed to the participant;
(F) Any additional information required by rules adopted under section 5110.35 173.83 of the Revised Code.
Sec.  5110.23 173.801(A) In accordance with rules adopted under section 5110.35 173.83 of the Revised Code and subject to section 5110.25 173.803 of the Revised Code, the department of job and family services aging shall make payments under the Ohio's best Rx program for complete and timely claims submitted under section 5110.22 173.80 of the Revised Code for drugs included in the program that are also included in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code. The payment for a complete and timely claim shall be made by a date that is not later than two weeks after the department receives the claim from the participating terminal distributor or the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code.
(B) Subject to division (D) of this section, the amount to be paid for a claim for a drug dispensed under the program shall be determined as follows:
(1) Compute the manufacturer payment amount that applies to the transaction, based on quantity of the drug dispensed and the drug's national drug code number, in accordance with the provisions of division (B) of section 5110.28 173.812 of the Revised Code;
(2) If rules adopted under section 5110.35 173.83 of the Revised Code require that program participants be charged an administrative fee for each transaction in which a quantity of the drug was dispensed, subtract from the amount computed under division (B)(1) of this section the administrative fee amount specified in those rules.
(C) The department may combine the claims submitted by a participating terminal distributor or the program's drug mail order system to make aggregate payments under this section to the distributor or system.
(D) If the total of the amounts computed under division (B) of this section for any period for which payments are due is a negative number, the participating terminal distributor or the program's drug mail order system that submitted the claims has been overpaid for the claims. When there is an overpayment, the department shall reduce future payments made under this section to the distributor or system or collect an amount from the distributor or system sufficient to reimburse the department for the overpayment.
Sec.  5110.24 173.802 Neither a participating terminal distributor nor the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code may be charged by the department of job and family services aging for the submission of a claim under section 5110.22 173.80 of the Revised Code or the processing of a claim under section 5110.23 173.801 of the Revised Code.
Sec.  5110.25 173.803The department of job and family services aging may not make a payment under section 5110.23 173.801 of the Revised Code for a claim submitted under section 5110.22 173.80 of the Revised Code if any of the following are the case:
(A) The claim is submitted by either a terminal distributor of dangerous drugs that is not a participating terminal distributor or a drug mail order system that is not the system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code.
(B) The claim is for a drug that is not included in the program.
(C) The claim is for a drug included in the program but the drug is dispensed to an individual who is not covered by an Ohio's best Rx program enrollment card.
(D) A person or government entity has paid the participating terminal distributor or the program's drug mail order system through any other prescription drug coverage program or prescription drug discount program for dispensing the drug, unless the payment is reimbursement for redeeming a coupon or is an amount directly paid by a drug manufacturer to the distributor or system for dispensing drugs to residents of a long-term care facility.
Sec. 5110.26 173.81For purposes of participating in the Ohio's best Rx program, any drug manufacturer may enter into an agreement with the department of job and family services aging under which the manufacturer agrees to make payments to the department with respect to one or more of the manufacturer's drugs when the one or more drugs are dispensed under the program. The terms of the agreement shall comply with section 5110.27 173.811 of the Revised Code.
Sec.  5110.27 173.811 (A) A manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code by a drug manufacturer and the department of job and family services aging shall include terms that do all of the following:
(1) Specify the time the agreement is to be in effect, which shall be not less than one year from the date the agreement is entered into;
(2) Specify which of the manufacturer's drugs are included in the agreement;
(3) Permit the department to remove a drug from the agreement in the event of a dispute over the drug's utilization;
(4) Require that the manufacturer specify a per unit amount that will be paid to the department for each drug included in the agreement that is dispensed to an Ohio's best Rx program participant;
(5) Require that the per unit amount specified by the manufacturer be an amount that the manufacturer believes is greater than or comparable to the per unit amount generally payable by the manufacturer for the same drug when the drug is dispensed to an individual using the outpatient drug coverage included in a health benefit plan offered in this state or another state to public employees or retirees and the eligible dependents of those employees or retirees;
(6) Require the manufacturer to make payments in accordance with the amounts computed under division (A) of section 5110.28 173.812 of the Revised Code;
(7) Require that the manufacturer make the payments on a quarterly basis or in accordance with a schedule established by rules adopted under section 5110.35 173.83 of the Revised Code.
(B) For any drug included in a manufacturer agreement, the terms of the agreement may provide for the establishment of a process for referring Ohio's best Rx program applicants and participants to a patient assistance program operated or sponsored by the manufacturer. The referral process may be included only if the manufacturer agrees to refer to the Ohio's best Rx program residents of this state who apply but are found to be ineligible for the patient assistance program.
Sec. 5110.28 173.812When a drug included in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code is dispensed under the Ohio's best Rx program, the manufacturer payment amount that applies to the transaction shall be established in accordance with the following:
(A) For purposes of the amount to be paid by the manufacturer, the manufacturer payment amount shall be computed by multiplying the per unit amount specified for the drug in the manufacturer agreement by the number of units dispensed.
(B) For purposes of the amount that a participant is to be charged under section 5110.10 173.75 of the Revised Code and the amount to be paid for claims under section 5110.23 173.801 of the Revised Code, both of the following apply:
(1) If a program administration percentage is not determined by the department of job and family services aging in rules adopted under section 5110.35 173.83 of the Revised Code, the manufacturer payment amount shall be the same as the manufacturer payment amount computed under division (A) of this section.
(2) If a program administration percentage is determined by the department, the manufacturer payment amount shall be computed as follows:
(a) Multiply the per unit amount specified for the drug in the agreement by the program administration percentage;
(b) Subtract the product determined under division (B)(2)(a) of this section from the per unit amount specified for the drug in the agreement;
(c) Multiply the per unit amount resulting from the computation under division (B)(2)(b) of this section by the number of units dispensed.
Sec. 5110.29 173.813In its negotiations with a drug manufacturer proposing to enter into an agreement under section 5110.26 173.81 of the Revised Code, the department of job and family services aging shall use the best information on manufacturer payments that is available to the department, including information obtained from the verifications made under section 5110.30 173.814 of the Revised Code by the Ohio's best Rx program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code. The department shall use the information in an attempt to obtain manufacturer payments that maximize the benefits provided to Ohio's best Rx program participants.
Sec. 5110.30 173.814Annually, the department of job and family services aging shall select a sample of not more than ten of the drugs that were included in the manufacturer agreements entered into under section 5110.26 173.81 of the Revised Code in the immediately preceding year. The department shall submit to the program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code information that identifies the per unit amount of the manufacturer payments that applied to each of the drugs in the sample.
The consulting pharmacy benefit manager shall review the submitted information. After the review, the consulting pharmacy benefit manager shall provide information to the department verifying whether any of the per unit payment amounts that applied to the selected drugs were more than two per cent lower than the per unit payment amounts negotiated by the consulting pharmacy benefit manager for the same drugs in connection with health benefit plans that generally do not use formularies to restrict the outpatient drug coverage included in the plans. The consulting pharmacy benefit manager shall specify which, if any, of the drugs in the sample were subject to the lower per unit payment amounts. The information provided to the department shall be certified by signature of an officer of the consulting pharmacy benefit manager.
Sec. 5110.31 173.815 (A) The department of job and family services aging shall seek from the centers for medicare and medicaid services of the United States department of health and human services written confirmation that manufacturer payments made pursuant to an agreement entered into under section 5110.26 173.81 of the Revised Code are exempt from the medicaid best price computation applicable under Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396r-8, as amended.
(B) Entering into a manufacturer agreement under section 5110.26 173.81 of the Revised Code does not require a drug manufacturer to make a manufacturer payment that would establish the manufacturer's medicaid best price for a drug.
Sec. 5110.32 173.82A drug manufacturer that enters into an agreement under section 5110.26 173.81 of the Revised Code may submit a request to the department of job and family services aging to audit claims submitted under section 5110.22 173.80 of the Revised Code. On submission of a request that the department considers reasonable, the department shall permit the manufacturer to audit the claims.
Sec. 5110.35 173.83 The department of job and family services aging shall adopt rules in accordance with Chapter 119. of the Revised Code to implement the Ohio's best Rx program. The rules shall provide for all of the following:
(A) Standards and procedures for establishing, pursuant to section 5110.07 173.74 of the Revised Code, the base price for each drug included in the program;
(B) Determination of family income for the purpose of division (A)(2)(a) of section 5110.14 173.76 of the Revised Code;
(C) For the purpose of section 5110.15 173.77 of the Revised Code, the application process for the program, including the information and documentation to be submitted with applications to verify eligibility and a process to be used in certifying that an applicant has attested to the accuracy of the submitted information and documentation;
(D) The method of providing information about the medicaid program to applicants under section 5110.16 173.771 of the Revised Code;
(E) For the purpose of section 5110.17 173.772 of the Revised Code, eligibility determination procedures;
(F) Standards and procedures governing the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code;
(G) Subject to section 5110.352 173.831 of the Revised Code, periodically increasing the maximum professional fee that participating terminal distributors may charge Ohio's best Rx program participants pursuant to an agreement entered into under section 5110.20 173.79 of the Revised Code;
(H) Subject to section 5110.353 173.832 of the Revised Code, the amount of the administrative fee, if any, that Ohio's best Rx program participants are to be charged under the program;
(I) The electronic method for submission of claims to the department under section 5110.22 173.80 of the Revised Code;
(J) Additional information to be included on claims submitted under section 5110.22 173.80 of the Revised Code that the department determines is necessary for the department to be able to make payments under section 5110.23 173.801 of the Revised Code;
(K) The method for making payments under section 5110.23 173.801 of the Revised Code;
(L) Subject to section 5110.354 173.833 of the Revised Code, the percentage, if any, that is the program administration percentage;
(M) If the department determines it is best that participating manufacturers make payments pursuant to manufacturer agreements entered into under section 5110.26 173.81 of the Revised Code on a basis other than quarterly, a schedule for making the payments;
(N) Procedures for making computations under sections 5110.10 173.75 and 5110.28 173.812 of the Revised Code;
(O) Standards and procedures for the use and preservation of records regarding the Ohio's best Rx program pursuant to section 5110.59 173.91 of the Revised Code;
(P) The efficient administration of other provisions of this chapter sections 173.71 to 173.91 of the Revised Code for which the department determines rules are necessary.
Sec. 5110.352 173.831 As used in this section, "medicaid dispensing fee" means the dispensing fee established under section 5111.071 of the Revised Code for the medicaid program.
In adopting a rule under division (F) of section 5110.35 173.83 of the Revised Code increasing the maximum amount of the professional fee participating terminal distributors may charge Ohio's best Rx program participants pursuant to an agreement entered into under section 5110.20 173.79 of the Revised Code, the department of job and family services aging shall review the amount of the professional fee once a year or, at the department's discretion, at more frequent intervals. The department shall not increase the professional fee to an amount exceeding the medicaid dispensing fee.
A participating terminal distributor may charge a maximum three dollar professional fee regardless of whether the medicaid dispensing fee for that drug is less than that amount. The department, however, may not adopt a rule increasing the maximum professional fee for that drug until the medicaid dispensing fee for that drug exceeds that amount.
Sec. 5110.353 173.832(A) Once a year or, at the discretion of the department of job and family services aging, at more frequent intervals, the department shall determine the amount, if any, that each Ohio's best Rx program participant will be charged as an administrative fee to be used in paying the administrative costs of the program. The fee, which shall not exceed one dollar per transaction, shall be specified in rules adopted under section 5110.35 173.83 of the Revised Code. In adopting the rules, the department shall specify a fee that results in an amount that equals or is less than the amount needed to cover the administrative costs of the Ohio's best Rx program when added to the sum of the following:
(1) The amount resulting from the program administration percentage, if the department determines a program administration percentage in rules adopted under section 5110.35 173.83 of the Revised Code;
(2) The investment earnings of the Ohio's best Rx program fund created by section 5110.42 173.85 of the Revised Code;
(3) Any amounts accepted by the department as donations to the Ohio's best Rx program fund.
(B) Once a year or, at the discretion of the department, at more frequent intervals, the department shall report the methodology underlying the determination of the administrative fee to the Ohio's best Rx program council.
Sec. 5110.354 173.833(A) At least once a year or, at the discretion of the department of job and family services aging, at more frequent intervals, the department shall determine the percentage, if any, of each manufacturer payment made under an agreement entered into under section 5110.26 173.81 of the Revised Code that will be retained by the department for use in paying the administrative costs of the Ohio's best Rx program. The percentage, which shall not exceed five per cent, shall be specified in rules adopted under section 5110.35 173.83 of the Revised Code. In adopting the rules, the department shall specify a percentage that results in an amount that equals or is less than the amount needed to cover the administrative costs of the Ohio's best Rx program when added to the sum of the following:
(1) The amount resulting from administrative fees, if the department determines an administrative fee in rules adopted under section 5110.35 173.83 of the Revised Code;
(2) The investment earnings of the Ohio's best Rx program fund created by section 5110.42 173.85 of the Revised Code;
(3) Any amounts accepted by the department as donations to the Ohio's best Rx program fund.
(B) Once a year or, at the discretion of the department, at more frequent intervals, the department shall report the methodology underlying the determination of the program administration percentage to the Ohio's best Rx program council.
Sec. 5110.36 173.84 Notwithstanding any conflicting provision of this chapter sections 173.71 to 173.91 of the Revised Code, the department of job and family services aging may adopt rules in accordance with Chapter 119. of the Revised Code to make adjustments to the Ohio's best Rx program that the department considers appropriate to conform the program to, or coordinate it with, any federally funded prescription drug program created after October 1, 2003.
Sec.  5110.42 173.85 (A) The Ohio's best Rx program fund is hereby created. The fund shall be in the custody of the treasurer of state, but shall not be part of the state treasury. The fund shall consist of the following:
(1) Manufacturer payments made by participating manufacturers pursuant to agreements entered into under section 5110.26 173.81 of the Revised Code;
(2) Administrative fees, if an administrative fee is determined by the department of job and family services aging in rules adopted under section 5110.35 173.83 of the Revised Code;
(3) Any amounts donated to the fund and accepted by the department;
(4) The fund's investment earnings.
(B) Money in the Ohio's best Rx program fund shall be used to make payments under section 5110.23 173.801 of the Revised Code and to make transfers to the Ohio's best Rx administration fund in accordance with section 5110.43 173.86 of the Revised Code.
Sec.  5110.43 173.86 (A) The Ohio's best Rx administration fund is hereby created in the state treasury. The treasurer of state shall transfer from the Ohio's best Rx program fund to the Ohio's best Rx administration fund amounts equal to the following:
(1) Amounts resulting from application of the program administration percentage, if a program administration percentage is determined by the department of job and family services aging in rules adopted under section 5110.35 173.83 of the Revised Code;
(2) The amount of the administrative fees charged Ohio's best Rx participants, if an administrative fee is determined by the department of job and family services aging in rules adopted under section 5110.35 173.83 of the Revised Code;
(3) The amount of any donations credited to the Ohio's best Rx program fund;
(4) The amount of investment earnings credited to the Ohio's best Rx program fund.
The treasurer of state shall make the transfers in accordance with a schedule developed by the treasurer of state and the department of job and family services aging.
(B) The department of job and family services aging shall use money in the Ohio's best Rx administration fund to pay the administrative costs of the Ohio's best Rx program, including, but not limited to, costs associated with contracted services, staff, outreach activities, computers and network services, and the Ohio's best Rx program council. If the fund includes an amount that exceeds the amount necessary to pay the administrative costs of the program, the department may use the excess amount to pay the cost of subsidies provided to Ohio's best Rx program participants under any subsidy program established pursuant to section 5110.39 173.861 of the Revised Code.
Sec. 5110.39 173.861The department of job and family services aging may establish a component of the Ohio's best Rx program under which subsidies are provided to participants to assist them with the cost of purchasing drugs under the program, including the cost of any professional fees charged for dispensing the drugs. The subsidies shall be provided only when the Ohio's best Rx program administration fund created under section 5110.43 173.86 of the Revised Code includes an amount that exceeds the amount necessary to pay the administrative costs of the program.
Sec. 5110.45 173.87 There is hereby created the Ohio's best Rx program council. The council shall advise the department of job and family services aging on the Ohio's best Rx program. With the approval of a majority of the council's appointed members, the council may initiate studies to determine whether there are more effective ways to administer the program and provide the department with suggestions for improvements.
Sec. 5110.46 173.871 The Ohio's best Rx program council shall consist of the following members:
(A) The president of the senate;
(B) The speaker of the house of representatives;
(C) The minority leader of the senate;
(D) The minority leader of the house of representatives;
(E) A representative of the Ohio chapter of the American federation of labor-congress of industrial organizations, appointed by the governor from a list of names submitted to the governor by that organization;
(F) A representative of the Ohio chapter of the American association of retired persons, appointed by the governor from a list of names submitted to the governor by that organization;
(G) A representative of a disability advocacy organization located in the state of Ohio, appointed by the governor from a list of names submitted to the governor by disability advocacy organizations located in the state of Ohio;
(H) A representative of the Ohio chapter of the united way, appointed by the governor from a list of names submitted to the governor by that organization;
(I) A representative of the Ohio alliance of retired Americans, appointed by the governor from a list of names submitted to the governor by that organization;
(J) Three representatives of research-based drug manufacturers, appointed by the governor from a list of names submitted to the governor by the pharmaceutical research and manufacturers of America;
(K) A pharmacist licensed under Chapter 4729. of the Revised Code, appointed by the governor from a list of names submitted to the governor by the Ohio pharmacists association.
Sec. 5110.47 173.872 The governor shall make initial appointments to the Ohio's best Rx program council not later than thirty days after the effective date of this section December 18, 2003. The members appointed by the governor shall serve at the pleasure of the governor. If an appointed member's seat becomes vacant, the governor shall fill the vacancy not later than thirty days after the vacancy occurs and in the manner provided for the initial appointment.
Sec. 5110.48 173.873 The president of the senate and speaker of the house of representatives shall serve as co-chairs of the Ohio's best Rx program council.
The president of the senate, the minority leader of the senate, the speaker of the house of representatives, and the minority leader of the house of representatives may each appoint a member of the general assembly to attend any meeting of the Ohio's best Rx program council on behalf of the president of the senate, the minority leader of the senate, the speaker of the house of representatives, or the minority leader of the house of representatives, respectively.
Sec. 5110.49 173.874 Members of the Ohio's best Rx program council shall serve without compensation and shall not be reimbursed for any expenses associated with their duties on the council.
Sec. 5110.50 173.875Except for any part of records that contain a trade secret, the Ohio's best Rx program council's records are a public record for the purpose of section 149.43 of the Revised Code.
Sec. 5110.51 173.876Sections 101.82 to 101.87 of the Revised Code do not apply to the Ohio's best Rx program council.
Sec.  5110.54 173.88(A) The department of job and family services aging shall compile both of the following lists regarding the Ohio's best Rx program:
(1) A list consisting of the name of each drug manufacturer that enters into a manufacturer agreement under section 5110.21 173.791 of the Revised Code and the names of the drugs included in each manufacturer agreement;
(2) A list consisting of the name of each participating terminal distributor and the name of the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code.
(B) As part of the list compiled under division (A)(1) of this section, the department may include aggregate information regarding the drugs selected under section 5110.30 173.814 of the Revised Code that were verified under that section as having per unit manufacturer payment amounts that were not more than two per cent lower than the per unit payment amounts negotiated for the same drugs by the program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code. The information shall not identify a specific drug and shall be expressed only as a percentage of the sample of drugs selected under section 5110.30 173.814 of the Revised Code.
(C) The lists compiled under this section are public records for the purpose of section 149.43 of the Revised Code. The department shall specifically make the lists available to physicians, participating terminal distributors, and other health professionals.
Sec. 5110.55 173.89 Information transmitted by or to any of the following for any purpose related to the Ohio's best Rx program is confidential to the extent required by federal and state law:
(A) Drug manufacturers;
(B) Terminal distributors of dangerous drugs;
(C) The department of job and family services aging;
(D) The program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code;
(E) Ohio's best Rx program participants;
(F) Any other government entity or person.
Sec. 5110.56 173.891 (A) Except as provided by section 5110.57 173.892 of the Revised Code, all of the following are trade secrets, are not public records for the purposes of section 149.43 of the Revised Code, and shall not be used, released, published, or disclosed in a form that reveals a specific drug or the identity of a drug manufacturer:
(1) The amounts determined under section 5110.23 173.801 of the Revised Code for payment of claims submitted by participating terminal distributors and the drug mail order system included in the Ohio's best Rx program pursuant to section 5110.19 173.78 of the Revised Code;
(2) Information disclosed in a manufacturer agreement entered into under section 5110.26 173.81 of the Revised Code or in communications related to an agreement;
(3) Drug pricing and drug manufacturer payment information verified under sections 5110.09 173.742 and 5110.30 173.814 of the Revised Code by the program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code;
(4) Information contained in or pertaining to an audit provided for by the program's consulting pharmacy benefit manager under section 5110.05 173.732 of the Revised Code;
(5) The elements of the computations made pursuant to sections 5110.10 173.75, 5110.23 173.801, and 5110.28 173.812 of the Revised Code and any results of those computations that reveal or could be used to reveal the manufacturer payment amounts used to make the computations.
(B) No person or government entity shall use or reveal any information specified in division (A) of this section except as required for the implementation of this chapter sections 173.71 to 173.91 of the Revised Code.
Sec. 5110.57 173.892 Sections 5110.55 173.89 and 5110.56 173.891 of the Revised Code shall not preclude the department of job and family services aging from disclosing information necessary for the implementation of this chapter sections 173.71 to 173.91 of the Revised Code, including the amount an Ohio's best Rx program participant is to be charged when the amount is disclosed under section 5110.11 173.751 of the Revised Code to participating terminal distributors or the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code.
Sec. 5110.58 173.90(A) As used in this section, "identifying information" means information that identifies or could be used to identify an Ohio's best Rx program applicant or participant. "Identifying information" does not include aggregate information about applicants and participants that does not identify and could not be used to identify an individual applicant or participant.
(B) Except as provided in divisions (C), (D), and (E) of this section, no person or government entity shall sell, solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information.
(C)(1) The department of job and family services aging may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information for a purpose directly connected to the administration of the Ohio's best Rx program, including disclosing and knowingly permitting the use of identifying information included in a claim that a participating manufacturer audits pursuant to section 5110.32 173.82 of the Revised Code, contacting Ohio's best Rx program applicants or participants regarding participation in the program, and notifying applicants and participants regarding participating terminal distributors and the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code.
(2) The department may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required by federal law.
(3) The department may disclose identifying information to the Ohio's best Rx program applicant or participant who is the subject of that information or to the parent, spouse, guardian, or custodian of that applicant or participant.
(D)(1) A participating terminal distributor may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required or permitted by an agreement the distributor enters into under section 5110.20 173.79 of the Revised Code.
(2) Subject to division (B) of section 5110.19 173.78 of the Revised Code, the drug mail order system included in the program pursuant to section 5110.19 173.78 of the Revised Code may solicit, disclose, receive, or use identifying information or knowingly permit the use of identifying information to the extent required or permitted by the department.
(E) A participating manufacturer may, for the purpose of auditing a claim pursuant to section 5110.32 173.82 of the Revised Code, solicit, receive, and use identifying information included in the claim.
Sec. 5110.59 173.91 (A) Except as provided in division (B) of this section, the department of job and family services aging shall use and preserve records regarding the Ohio's best Rx program in accordance with rules adopted under section 5110.35 173.83 of the Revised Code. The department shall use and preserve the records in accordance with those rules, regardless of whether the department generated the records or received them from another government entity or any person.
(B) All records received by the department under sections 5110.09 173.742 and 5110.30 173.814 of the Revised Code from the program's consulting pharmacy benefit manager selected under section 5110.04 173.731 of the Revised Code shall be destroyed promptly after the department has completed the purpose for which the information contained in the records was obtained.
Sec. 173.99.  (A) A long-term care provider, person employed by a long-term care provider, other entity, or employee of such other entity that violates division (C) of section 173.24 of the Revised Code is subject to a fine not to exceed one thousand dollars for each violation.
(B) Whoever violates division (C) of section 173.23 of the Revised Code is guilty of registering a false complaint, a misdemeanor of the first degree.
(C) A long-term care provider, other entity, or person employed by a long-term care provider or other entity that violates division (E) of section 173.19 of the Revised Code by denying a representative of the office of the state long-term care ombudsperson program the access required by that division is subject to a fine not to exceed five hundred dollars for each violation.
(D) Whoever violates division (C) of section 173.44 of the Revised Code is subject to a fine of one hundred dollars.
(E) Whoever violates division (B) of section 173.90 of the Revised Code is guilty of a misdemeanor of the first degree.
Sec. 2921.13.  (A) No person shall knowingly make a false statement, or knowingly swear or affirm the truth of a false statement previously made, when any of the following applies:
(1) The statement is made in any official proceeding.
(2) The statement is made with purpose to incriminate another.
(3) The statement is made with purpose to mislead a public official in performing the public official's official function.
(4) The statement is made with purpose to secure the payment of unemployment compensation; Ohio works first; prevention, retention, and contingency benefits and services; disability financial assistance; retirement benefits; economic development assistance, as defined in section 9.66 of the Revised Code; or other benefits administered by a governmental agency or paid out of a public treasury.
(5) The statement is made with purpose to secure the issuance by a governmental agency of a license, permit, authorization, certificate, registration, release, or provider agreement.
(6) The statement is sworn or affirmed before a notary public or another person empowered to administer oaths.
(7) The statement is in writing on or in connection with a report or return that is required or authorized by law.
(8) The statement is in writing and is made with purpose to induce another to extend credit to or employ the offender, to confer any degree, diploma, certificate of attainment, award of excellence, or honor on the offender, or to extend to or bestow upon the offender any other valuable benefit or distinction, when the person to whom the statement is directed relies upon it to that person's detriment.
(9) The statement is made with purpose to commit or facilitate the commission of a theft offense.
(10) The statement is knowingly made to a probate court in connection with any action, proceeding, or other matter within its jurisdiction, either orally or in a written document, including, but not limited to, an application, petition, complaint, or other pleading, or an inventory, account, or report.
(11) The statement is made on an account, form, record, stamp, label, or other writing that is required by law.
(12) The statement is made in connection with the purchase of a firearm, as defined in section 2923.11 of the Revised Code, and in conjunction with the furnishing to the seller of the firearm of a fictitious or altered driver's or commercial driver's license or permit, a fictitious or altered identification card, or any other document that contains false information about the purchaser's identity.
(13) The statement is made in a document or instrument of writing that purports to be a judgment, lien, or claim of indebtedness and is filed or recorded with the secretary of state, a county recorder, or the clerk of a court of record.
(14) The statement is made with purpose to obtain an Ohio's best Rx program enrollment card under section 5110.18 173.773 of the Revised Code or a payment under section 5110.23 173.801 of the Revised Code.
(15) The statement is made in an application filed with a county sheriff pursuant to section 2923.125 of the Revised Code in order to obtain or renew a license to carry a concealed handgun or is made in an affidavit submitted to a county sheriff to obtain a temporary emergency license to carry a concealed handgun under section 2923.1213 of the Revised Code.
(16) The statement is required under section 5743.72 of the Revised Code in connection with the person's purchase of cigarettes or tobacco products in a delivery sale.
(B) No person, in connection with the purchase of a firearm, as defined in section 2923.11 of the Revised Code, shall knowingly furnish to the seller of the firearm a fictitious or altered driver's or commercial driver's license or permit, a fictitious or altered identification card, or any other document that contains false information about the purchaser's identity.
(C) No person, in an attempt to obtain a license to carry a concealed handgun under section 2923.125 of the Revised Code, shall knowingly present to a sheriff a fictitious or altered document that purports to be certification of the person's competence in handling a handgun as described in division (B)(3) of section 2923.125 of the Revised Code.
(D) It is no defense to a charge under division (A)(6) of this section that the oath or affirmation was administered or taken in an irregular manner.
(E) If contradictory statements relating to the same fact are made by the offender within the period of the statute of limitations for falsification, it is not necessary for the prosecution to prove which statement was false but only that one or the other was false.
(F)(1) Whoever violates division (A)(1), (2), (3), (4), (5), (6), (7), (8), (10), (11), (13), (14), or (16) of this section is guilty of falsification, a misdemeanor of the first degree.
(2) Whoever violates division (A)(9) of this section is guilty of falsification in a theft offense. Except as otherwise provided in this division, falsification in a theft offense is a misdemeanor of the first degree. If the value of the property or services stolen is five hundred dollars or more and is less than five thousand dollars, falsification in a theft offense is a felony of the fifth degree. If the value of the property or services stolen is five thousand dollars or more and is less than one hundred thousand dollars, falsification in a theft offense is a felony of the fourth degree. If the value of the property or services stolen is one hundred thousand dollars or more, falsification in a theft offense is a felony of the third degree.
(3) Whoever violates division (A)(12) or (B) of this section is guilty of falsification to purchase a firearm, a felony of the fifth degree.
(4) Whoever violates division (A)(15) or (C) of this section is guilty of falsification to obtain a concealed handgun license, a felony of the fourth degree.
(G) A person who violates this section is liable in a civil action to any person harmed by the violation for injury, death, or loss to person or property incurred as a result of the commission of the offense and for reasonable attorney's fees, court costs, and other expenses incurred as a result of prosecuting the civil action commenced under this division. A civil action under this division is not the exclusive remedy of a person who incurs injury, death, or loss to person or property as a result of a violation of this section.
Section 5. That existing sections 127.16, 173.06, 173.062, 173.99, 2921.13, 5110.01, 5110.02, 5110.021, 5110.03, 5110.04, 5110.05, 5110.07, 5110.08, 5110.09, 5110.10, 5110.11, 5110.12, 5110.13, 5110.14, 5110.15, 5110.16, 5110.17, 5110.18, 5110.19, 5110.20, 5110.21, 5110.22, 5110.23, 5110.24, 5110.25, 5110.26, 5110.27, 5110.28, 5110.29, 5110.30, 5110.31, 5110.32, 5110.35, 5110.352, 5110.353, 5110.354, 5110.36, 5110.37, 5110.38, 5110.39, 5110.40, 5110.42, 5110.43, 5110.45, 5110.46, 5110.47, 5110.48, 5110.49, 5110.50, 5110.51, 5110.54, 5110.55, 5110.56, 5110.57, 5110.58, and 5110.59 and sections 173.061, 173.07, 173.071, 173.072, and 5110.99 of the Revised Code are hereby repealed.
Section 6. Sections 4 and 5 of this act take effect July 1, 2007.
Section 7. On July 1, 2007, the Ohio's Best Rx Program and all of its functions, assets, and liabilities are transferred from the Department of Job and Family Services to the Department of Aging. The transferred Program is thereupon and thereafter successor to, assumes the obligations of, and otherwise constitutes the continuation of the Program as it was operated under Chapter 5110. of the Revised Code immediately prior to July 1, 2007.
Any Program business commenced but not completed before July 1, 2007, shall be completed by the Department of Aging under sections 173.71 to 173.91 of the Revised Code. The business shall be completed in the same manner, and with the same effect, as if completed by the Department of Job and Family Services under Chapter 5110. of the Revised Code immediately prior to July 1, 2007.
No validation, cure, right, privilege, remedy, obligation, or liability pertaining to the Program is lost or impaired by reason of the Program's transfer from the Department of Job and Family Services to the Department of Aging. Each such validation, cure, right, privilege, remedy, obligation, or liability shall be administered by the Department of Aging pursuant to sections 173.71 to 173.91 of the Revised Code.
All rules, orders, and determinations pertaining to the Program as it was operated under Chapter 5110. of the Revised Code immediately prior to July 1, 2007, continue in effect as rules, orders, and determinations of the Program under sections 173.71 to 173.91 of the Revised Code, until modified or rescinded by the Department of Aging. If necessary to ensure the integrity of the numbering of the Administrative Code, the Director of the Legislative Service Commission shall renumber the rules to reflect the transfer of the Program from the Department of Job and Family Services to the Department of Aging.
Subject to the lay-off provisions of sections 124.321 to 124.328 of the Revised Code, all of the Program's employees in the Department of Job and Family Services shall be transferred to the Department of Aging. The transferred employees shall retain their positions and all of the benefits accruing to those positions.
The Director of Budget and Management shall determine the amount of the unexpended balances in the appropriation accounts that pertain to the Program as it was operated under Chapter 5110. of the Revised Code immediately prior to July 1, 2007, and shall recommend to the Controlling Board their transfer to the appropriation accounts that pertain to the Department of Aging. The Department of Job and Family Services shall provide full and timely information to the Controlling Board to facilitate this transfer.
In anticipation of the Program's transfer to the Department of Aging, the Department may negotiate or enter into a contract with a person to serve as the Program administrator beginning on or after July 1, 2007. When negotiating or entering into the contract, the Department shall comply with the same provisions that apply to the Department of Job and Family Services under section 5110.021 of the Revised Code.
Please send questions and comments to the Webmaster.
© 2014 Legislative Information Systems | Disclaimer
Index of Legislative Web Sites