Bill > SB840

This bill creates a new section in Missouri state law that establishes rules for how health carriers and pharmacy benefits managers calculate cost-sharing and out-of-pocket maximums for health benefit plan enrollees. Specifically, the bill requires that when calculating an enrollee's out-of-pocket expenses, the health carrier must include any amounts paid by the enrollee for medications where no generic drug substitute is available. The bill also 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 includes provisions to ensure compatibility with health savings account regulations and does not interfere with existing step therapy practices. Key terms are carefully defined, including "cost-sharing" (which encompasses co-payments, coinsurance, and deductibles), "generic drug", and "health benefit plan". The provisions will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, and notably exclude health benefit plans covered under the Labor Management Relations Act. The bill aims to provide more transparent and potentially more affordable healthcare cost calculations for enrollees.

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https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=210