Bill > HB474

This bill creates new provisions related to prescription drug payments and pharmacy benefit managers (PBMs), focusing on protecting patients' rights and increasing transparency in drug pricing. The legislation establishes several key requirements for PBMs, including prohibiting them from restricting patients' choices of pharmacies, mandating that PBMs disclose potential conflicts of interest to health plan sponsors, and preventing PBMs from charging pharmacies unfair fees or reducing claim payments. The bill also introduces new definitions for terms like "covered person" and "rebate", and requires PBMs to owe a fiduciary duty to health benefit plan sponsors. Additionally, the bill requires health carriers and PBMs to include certain medication costs in out-of-pocket maximums, particularly for medications without generic alternatives, and prevents them from designing benefits that discriminate based on the availability of cost-sharing assistance programs. The legislation aims to increase transparency, reduce hidden costs, and provide more protections for patients and pharmacies in the prescription drug payment system.

https://house.mo.gov/Bill.aspx?bill=HB474&year=2025&code=R