Bill > HB982

This bill creates new provisions related to prescription drug payments and pharmacy benefits managers (PBMs), with several key components. It ensures patients' freedom to choose their pharmacy and receive prescriptions from their preferred facility, and prohibits PBMs from penalizing or restricting patients from obtaining prescription services, consultations, or advice from contracted pharmacies. The bill establishes detailed regulations for PBMs, including requiring them to disclose conflicts of interest, owe a fiduciary duty to health benefit plan sponsors, and provide transparent pricing and rebate information. It sets specific rules about maximum allowable cost (MAC) pricing for drugs, creating an appeals process for pharmacies to challenge reimbursement rates and requiring PBMs to update pricing information at least every seven days. The bill also introduces provisions about cost-sharing calculations, mandating that health carriers include all medication costs in out-of-pocket maximums, especially for medications without generic alternatives, and prohibiting benefit designs that discriminate based on cost-sharing assistance programs. Additionally, the bill prevents PBMs from charging pharmacies undisclosed fees, requires consistent reimbursement rates across pharmacies, and establishes new definitions and reporting requirements to increase transparency in prescription drug pricing and pharmacy benefits management.

Government Affairs, Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB982&year=2025&code=R