State Tracker Updated June 15, 2026

Ohio: what the PBM reimbursement law requires

Ohio bans spread pricing and runs Medicaid pharmacy through a single PBM on a NADAC-based fee-for-service rate, and its 2026 law adds PBM licensure, transparency, and MAC appeals — but there is no commercial reimbursement floor.

Status	Partially enacted
Law	H.B. 229 (2026) PBM licensure; Medicaid spread-pricing reform (H.B. 166, 2019)
Effective date	Licensure effective July 1, 2027; Medicaid spread-pricing ban in effect since 2019
Reimbursement basis	No commercial reimbursement floor. Ohio bans Medicaid spread pricing and reimburses Medicaid pharmacy through a single PBM on a NADAC-based fee-for-service rate; the 2026 law adds PBM licensure, fiduciary duty to the insurer, transparency, and audit authority. An affiliate-parity rate protection was removed before passage, leaving no commercial floor.
Professional dispensing fee	Not specified for commercial plans (the Medicaid fee-for-service dispensing fee is set by the Medicaid program)
Appeal route	Under Ohio's MAC transparency law, a pharmacy has 21 days to appeal and the PBM 21 days to decide

Ohio’s pharmacy reforms are real but stop short of a commercial reimbursement floor. On the Medicaid side, the state banned spread pricing and consolidated pharmacy benefits under a single PBM that reimburses on a NADAC-based fee-for-service methodology. On the commercial side, the 2026 PBM law (H.B. 229) adds standalone PBM licensure, a fiduciary duty to the insurer, transparency, and audit authority, with licensure effective July 1, 2027.

An affiliate-parity provision that would have constrained reimbursement was removed from H.B. 229 before passage, so commercial plans have no statutory rate floor — only the longstanding MAC transparency law, under which a pharmacy has 21 days to appeal and the PBM 21 days to decide.

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