Bill > SB846

This bill enacts several provisions related to insurance coverage of health care services, focusing on protecting healthcare providers and patients from certain restrictive practices by health carriers and pharmacy benefits managers. The bill introduces new sections to Missouri law that prohibit health carriers from imposing penalties or limitations on providers and patients when it comes to clinician-administered drugs, biological products, and drugs purchased through the 340B drug pricing program. Specifically, it prevents carriers from discriminating against providers based on how or where they obtain drugs, ensures consistent coverage for biosimilar products, and protects covered entities like hospitals from unfair reimbursement practices. The bill also establishes significant changes to prior authorization requirements, mandating that starting January 1, 2027, health carriers cannot require prior authorization for healthcare services from providers who have historically approved over 90% of their requests. Hospitals can qualify for exemption from prior authorization by meeting certain quality or value-based care criteria. The legislation includes provisions for notification, appeals, and online portals for tracking prior authorization requests, and imposes potential civil penalties for non-compliance. The bill does not apply to MO HealthNet (Medicaid) directly, though Medicaid managed care organizations are considered health carriers for these purposes, and it includes safeguards to prevent providers from practicing outside their licensed scope.

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https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=237