Bill > SB970

This bill, concerning cost-sharing under health benefit plans, mandates that when calculating an enrollee's total contribution towards out-of-pocket maximums or other cost-sharing requirements, health carriers and pharmacy benefits managers must include any amounts paid by or on behalf of the enrollee for medications for which a generic drug substitute is not available. Cost-sharing refers to any co-payment, coinsurance, deductible, or similar charge an enrollee pays for a covered health care service. The bill also prohibits health carriers and pharmacy benefits managers from adjusting an enrollee's out-of-pocket maximum or cost-sharing based on the availability of assistance programs for these specific medications. An exception is made for health savings account-qualified high deductible health plans to maintain their tax-advantaged status under federal law, with specific rules applying after the minimum deductible is met, except for preventive care. The provisions do not apply to plans covered by the Labor Management Relations Act of 1947 and will take effect for plans entered into, amended, extended, or renewed on or after August 28, 2026.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=132