Bill > HB1681

This bill creates a new section in Missouri law that establishes regulations for cost-sharing in health benefit plans, specifically focusing on how medications without generic alternatives are treated. The bill defines several key terms, including "cost-sharing" as any out-of-pocket expenses like copayments or deductibles required by an enrollee for health care services. It mandates that health carriers and pharmacy benefits managers must include amounts paid by an enrollee for medications without generic substitutes when calculating out-of-pocket maximums. The bill prohibits health carriers 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 legislation includes special provisions for health savings account-qualified high deductible health plans to ensure compliance with federal tax laws, and it does not prevent the use of step therapy protocols. The bill will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, and specifically excludes health plans covered under the Labor Management Relations Act. The primary aim of this bill appears to be protecting patients from potentially discriminatory cost-sharing practices related to medications without generic alternatives.

Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB1681&year=2026&code=R