Bill > SB512

This bill establishes comprehensive new regulations for pharmacy benefits managers (PBMs) and prescription drug payments in Missouri, focusing on protecting patients' rights and increasing transparency in the prescription drug market. The legislation creates several key provisions: pharmacists must be allowed to provide pharmaceutical consultations and advice, patients can choose their preferred pharmacy, and PBMs are prohibited from restricting a patient's ability to obtain prescriptions from contracted pharmacies. The bill introduces new definitions for terms like "covered person" and "rebate", mandates that PBMs disclose potential conflicts of interest, and requires them to define terms like "generic" consistently. PBMs are now required to maintain a transparent process for determining maximum allowable drug costs, provide an appeals process for pharmacies challenging reimbursement rates, and cannot reimburse pharmacies at rates lower than their affiliate pharmacies. Additionally, the bill requires health carriers to include all medication costs in calculating out-of-pocket maximums, especially for medications without generic alternatives, and prevents carriers from designing benefits that discriminate based on the availability of cost-sharing assistance programs. The legislation aims to create more fairness and transparency in prescription drug pricing and pharmacy reimbursement practices.

Health and Social Services

https://www.senate.mo.gov/25info/BTS_Web/Bill.aspx?SessionType=R&BillID=565903