Bill > SB1448

This bill creates new provisions relating to cost-sharing requirements for health benefit plans in Missouri, establishing rules about how out-of-pocket expenses are calculated and managed. Specifically, the bill requires health carriers and pharmacy benefits managers to include any amounts paid by an enrollee for medications without a generic drug substitute when calculating the enrollee's overall out-of-pocket maximum. The legislation 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 bill defines key terms like "cost-sharing", "generic drug", and "health benefit plan", and includes special provisions for health savings account-qualified high deductible health plans. The new requirements will apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026, and do not apply to certain federally regulated health plans under the Labor Management Relations Act. The bill also explicitly allows health carriers to continue using step therapy protocols and ensures that the provisions do not interfere with existing medication management strategies.

Health and Social Services

https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=19783