Bill > SB968

This bill modifies regulations for pharmacy benefits managers (PBMs), which are entities that process prescription drug claims and manage pharmacy networks for health insurance plans. The bill introduces several key provisions to protect pharmacies and patients: PBMs cannot prohibit patients from choosing their preferred pharmacy or impose financial penalties for such choices; PBMs cannot require pharmacies to meet credentialing standards beyond state licensing requirements; and PBMs must reimburse pharmacies at rates no less than the National Average Drug Acquisition Cost (NADAC). The legislation establishes a formal appeals process for pharmacies to challenge reimbursement rates, requiring PBMs to respond to appeals within 14 days and prohibiting retaliation against pharmacies that file appeals. Additionally, the bill mandates that PBMs update their drug pricing lists at least every seven days, ensure multiple generic drug options are available before setting maximum allowable cost pricing, and provide clear explanations for denied appeals. The overall aim is to increase transparency, fairness, and competition in pharmacy reimbursement practices, ultimately protecting the interests of pharmacies and patients.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=130