Bill > HB1975

This bill modifies regulations for pharmacy benefits managers (PBMs), which are entities that process prescription drug claims for health insurance plans. The bill introduces new definitions for key terms like "covered person" and "health benefit plan" and establishes several prohibitions on PBM practices. Specifically, PBMs are now prohibited from: restricting a patient's choice of pharmacy, imposing additional certification requirements beyond state licensing standards, and reimbursing pharmacies at rates lower than the National Average Drug Acquisition Cost. The bill also mandates that PBMs provide a transparent appeals process for pharmacies challenging reimbursement rates, with specific timelines for responding to appeals. Additionally, PBMs must reimburse pharmacies at rates comparable to their own affiliated pharmacies and provide a dispensing fee of at least 90% of the MO HealthNet professional dispensing fee. The legislation aims to increase fairness, transparency, and competition in pharmacy reimbursement practices, protecting both patients and pharmacies from potentially exploitative PBM practices.