Bill > HB2279

This bill creates new provisions for how health insurance carriers and pharmacy benefits managers (PBMs) must calculate and handle cost-sharing requirements for medications without generic drug alternatives. Specifically, the bill requires that when calculating an enrollee's out-of-pocket maximum or cost-sharing requirements, the health carrier or PBM must include any amounts paid by or on behalf of the enrollee for medications without a generic substitute. The bill also prohibits health carriers and PBMs 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. For health savings account-qualified high deductible health plans, the requirement applies after the enrollee has met the minimum deductible, with exceptions for preventive care. The bill does not prevent the use of step therapy and does not apply to health benefit plans covered under the Labor Management Relations Act. These provisions will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, and includes detailed definitions for terms like "cost-sharing", "enrollee", "generic drug", and other relevant healthcare-related terminology.

Health and Social Services

https://house.mo.gov/Bill.aspx?bill=HB2279&year=2026&code=R