Bill > SB984

This bill modifies regulations for pharmacy benefit managers (PBMs), which are intermediaries that manage prescription drug benefits for health plans. The bill introduces numerous provisions to increase transparency and fairness in PBM practices, including requiring PBMs to: provide detailed pharmacy claims data to plan sponsors, update drug pricing at least every seven days, maintain an appeals process for pharmacies challenging reimbursement rates, disclose any conflicts of interest or affiliated pharmacies, and provide documentation of benefit designs. The bill also establishes stricter audit guidelines for pharmacies, limiting the number and scope of audits, preventing recoupment for minor clerical errors, and ensuring that audits are conducted fairly. Key protections include prohibiting PBMs from charging fees not known at claim adjudication, allowing pharmacists to discuss alternative drug costs with patients, and requiring PBMs to reimburse pharmacies based on current market pricing. Additionally, the bill mandates that PBMs owe a fiduciary duty to plan sponsors and allows the Department of Commerce and Insurance to audit PBMs for compliance. The legislation aims to create more accountability and reduce potentially unfair practices in prescription drug benefit management.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=109