Bill > HB1850

This bill modifies provisions related to pharmacy audits, pharmacy benefits managers (PBMs), and pharmacy operations in Missouri. The bill establishes detailed requirements for how entities like insurance companies and PBMs can conduct pharmacy audits, including providing at least 14 days' notice before an audit, limiting audits to 25 randomly selected prescriptions, restricting audit frequency to two times per calendar year, and prohibiting recoupment for minor clerical errors. The bill also creates new transparency requirements for PBMs, mandating they disclose financial relationships, provide detailed pharmacy claims data to plan sponsors, and owe a fiduciary duty to those sponsors. Additionally, the legislation introduces a critical access care pharmacy program to support pharmacies in areas with limited pharmacy services and establishes new rules about maximum allowable cost pricing for prescription drugs. Key protections are added for pharmacies, such as allowing them to appeal reimbursement disputes, preventing PBMs from charging unexpected fees, and ensuring pharmacists can discuss alternative, more affordable drug options with patients. The bill aims to increase oversight of PBMs, protect pharmacies from overly punitive audit practices, and improve transparency in prescription drug pricing and reimbursement.

Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB1850&year=2026&code=R