Bill > SB187

This bill requires health carriers and pharmacy benefits managers to include any amounts paid by or on behalf of an enrollee toward their cost-sharing when calculating out-of-pocket maximums, specifically for medications without generic alternatives. The bill defines key terms like "cost-sharing" (which includes co-payments, coinsurance, deductibles, and similar charges), "enrollee", "health benefit plan", and "health carrier" by referencing existing state statutes. For health savings account-qualified high deductible health plans, the requirement applies after the enrollee has met the minimum deductible, with an exception for preventive care services where the requirement applies regardless of deductible status. The bill ensures that third-party payments (such as from assistance programs or foundations) will count toward an individual's total cost-sharing, potentially making medications more affordable for patients. The legislation does not prevent health carriers from using step therapy protocols, which typically require patients to try less expensive treatments before more costly ones. This bill aims to provide more transparency and potentially reduce out-of-pocket expenses for patients by counting all payments toward their cost-sharing requirements.

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https://www.senate.mo.gov/25info/BTS_Web/Bill.aspx?SessionType=R&BillID=142