Within the first quarter of 2026, the Ohio State Senate is expected to review and vote on whether to enact House Bill 229 (HB 229), a pending piece of legislation aimed at regulating pharmacy benefit managers (PBMs) that has the potential to significantly alter the balance of power between PBMs and independent pharmacies in Ohio. For pharmacists and pharmacy owners surveying the national regulatory landscape and evaluating how upcoming state-level PBM reforms could affect day-to-day operations, reimbursement, and compliance, HB 229 is legislation certainly worth watching in 2026. At its core, HB 229 targets areas of PBM conduct and pharmacy-payer dynamics that, if enacted, would materially reshape elements of the Ohio pharmacy marketplace.
House Bill 229: A History
HB 229 was initially introduced in the Ohio House of Representatives on April 9, 2025, by members focused on pharmacy access, fairness in reimbursement, and PBM oversight, with the bill’s primary sponsor being Rep. Kellie Deeter. Ultimately, the Ohio House passed HB 229 on October 14, 2025, at which time the bill was sent to the Ohio Senate Committee on Financial Institutions, Insurance, and Technology for review prior to being brought to the Ohio Senate floor.
To date, the bill has drawn widespread bipartisan support, reflecting sustained national interest in PBM transparency and accountability. The proposed text of HB 229 aligns with broader nationwide trends toward regulating key industry practices, including reimbursement methodologies, network design, spread pricing, retroactive fees, audit practices, and patient steering. Notably, even the United States Congress is actively pushing to pass legislation aimed at PBM reform. Pharmacists who stay up to date on these regulatory trends will know that the topics HB 229 seeks to address have been front and center for Ohio pharmacies over the past several years.
Key Provisions of the Bill
While the bill’s language may change during the Senate’s Committee process, HB 229, as currently drafted, addresses several recurring themes in PBM regulation that are critical for pharmacies:
- Transparency and pricing methodology. HB 229 seeks to constrain opaque pricing practices by requiring clearer disclosure of reimbursement methodologies and restricting spread pricing in certain arrangements. This may include mandates for pass-through pricing, prohibitions on charging payers more than amounts paid to pharmacies plus an administrative fee, and reporting obligations that shed light on PBM revenue sources.
- Fair reimbursement, MAC appeals, retroactive fees, and clawbacks. The bill tightens requirements governing maximum allowable cost (MAC) lists, the benchmarks PBMs use to set reimbursement rates for generic drugs. Under HB 229, PBMs must adhere to defined standards for which drugs may be included on MAC lists and how frequently those lists must be updated. The bill also guarantees pharmacies access to a timely appeals process when a drug’s acquisition cost exceeds the allowed reimbursement, along with meaningful remedies when appeals succeed. In addition, HB 229 targets the widespread practice of post-adjudication recoupments, often characterized as direct and indirect remuneration (DIR) fees or performance-based adjustments, through which PBMs reduce pharmacy payments after claims have already been processed. The bill limits retroactive reductions on clean claims, establishes notice and calculation standards, and restricts both the timing and permissible grounds for any after-the-fact payment adjustments. The issue of retroactive negative adjustments has drawn increased scrutiny, including a widely reported enforcement action in which the Oklahoma Attorney General issued a cease-and-desist order against OptumRx stemming from alleged improper clawbacks.
- Network access and steering. HB 229 also targets well-documented PBM practices of patient steering and anti-competitive network conduct. Specifically, the bill restricts practices that favor affiliated pharmacies, imposes network adequacy and geographic access requirements, and limits discriminatory accreditation or credentialing mandates. These latter provisions are particularly significant for independent pharmacies, as such mandates often function as de facto exclusion criteria that disadvantage independents seeking to compete with vertically integrated retail pharmacy chains.
- Audit standards. The bill would also strengthen pharmacy audit due process rights through its inclusion of notice requirements, record review parameters, extrapolation limits, timelines, and error categorization aimed at distinguishing immaterial clerical discrepancies from fraud or overpayment, a distinction frequently blurred by PBMs seeking to terminate their provider agreements with otherwise substantially compliant pharmacies.
- Enforcement. Lastly, HB 229 is designed to provide effective enforcement mechanisms for these provisions. Proponents of the bill expect clearer agency oversight, complaint procedures, investigatory authority, civil penalties, and private or administrative remedies that give these provisions the teeth required to take a bite out of the ever-growing monopolistic tendencies of PBMs. Importantly, HB 229 also provides effective enforcement details that are central to real-world impact such as who regulates the PBMs, how violations are proven, and what relief is available.
Why Independent Pharmacists Should Care
For independent pharmacists, the stakes are clear. HB 229’s transparency and pass-through provisions can improve visibility into PBM reimbursement, enabling better inventory purchasing and margin management. Stronger MAC and appeals rules can prevent sustained below-cost dispensing and provide a path to prompt make-whole adjustments. Guardrails on retroactive fee adjustment reduces unpredictability that disrupts cash flow and complicates forecasting. Network and anti-steering provisions can protect patient access to local pharmacies and curb anti-competitive leverage against small businesses. Improvements in audit due process can reduce administrative drag and minimize the risk of disproportionate recoupments for minor documentation issues. Taken together, HB 229 can materially impact profitability, staffing decisions, service offerings (e.g., clinical programs), and capital planning for independent pharmacies across Ohio.
How Frier Levitt Can Help
As experienced healthcare attorneys with a national PBM and payer-regulatory practice, the attorneys at Frier Levitt are well-versed in navigating newly enacted state PBM frameworks and interpreting complex statutory language. They also engage with regulators during rulemaking, advising on contract and network strategy, retooling audit readiness, and operationalizing new pricing and fee limitations. Pharmacies interested in preparing to navigate HB 229’s provisions once passed should reach out to Frier Levitt for more information on how to skillfully utilize new regulations to their advantage. Early review of a pharmacy’s payer and PBM agreements, reimbursement data, audit protocols, and network positions can position one’s business to comply efficiently while simultaneously capturing the benefits the legislature intends to provide for patient access and fair pharmacy compensation.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
