Bill > HB1941

This bill, concerning cost-sharing under health benefit plans, mandates that when calculating an enrollee's (the person covered by the plan) total contribution towards their out-of-pocket maximum or any cost-sharing requirement, health carriers (insurance companies) and pharmacy benefits managers (companies that manage prescription drug benefits) must include any amounts paid by or on behalf of the enrollee for medications where a generic drug substitute is not available. It also prohibits these entities from changing an enrollee's out-of-pocket maximum or cost-sharing based on the availability of assistance programs for such medications, and prevents them from designing benefits in a way that considers such assistance. The bill includes specific provisions for health savings account-qualified high deductible health plans to avoid ineligibility under federal law, and clarifies that it does not prohibit step therapy (requiring patients to try a less expensive drug before a more expensive one) or apply to plans covered by the Labor Management Relations Act of 1947. These provisions are set to take effect for health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, with specific language to ensure federal exemptions remain intact.

Government Affairs, Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB1941&year=2026&code=R