Bill > SB1327

This bill creates new provisions for how health carriers and pharmacy benefits managers must calculate and handle cost-sharing in health benefit plans. Specifically, the bill requires that when calculating an enrollee's out-of-pocket maximum or cost-sharing requirements, carriers must include amounts paid by the enrollee for medications without a generic drug substitute. 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 medications without generic alternatives. The legislation provides specific definitions for terms like "cost-sharing", "enrollee", and "generic drug", drawing from existing state and federal regulations. There are exceptions for certain health plans covered under federal labor laws, and provisions related to health savings account compatibility. The bill includes a provision that these requirements will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, and does not restrict the use of step therapy protocols. The overall aim appears to be protecting patients from potentially unfair cost-sharing practices, particularly for medications without generic alternatives.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=178