Bill > HB79

This bill creates new provisions for how health insurance carriers and pharmacy benefits managers (PBMs) must calculate and handle cost-sharing for medications, specifically when a generic drug substitute is not available. The bill defines key terms like "cost-sharing" (which includes co-payments, coinsurance, and deductibles) and establishes that when calculating an enrollee's out-of-pocket maximum, the carrier or PBM must include amounts paid for medications without generic alternatives. The bill prohibits health carriers and PBMs from varying out-of-pocket maximums or designing benefits in a way that takes into account the availability of cost-sharing assistance programs for such medications. The bill includes a special provision for health savings account-qualified high deductible health plans to ensure compliance with federal tax law, and it does not prevent the use of step therapy protocols. The new requirements will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2025, and explicitly do not apply to health plans covered under the Labor Management Relations Act. The goal appears to be protecting patients from potentially unfair cost-sharing practices for medications without generic alternatives.

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https://house.mo.gov/Bill.aspx?bill=HB79&year=2025&code=R