Healthcare (Prescription Drugs)

HB 1941 requires health insurance plans in Missouri to count payments for non-generic medications toward a patient's annual out-of-pocket maximum. Specifically, health carriers must include costs paid by enrollees for medications where a generic version is unavailable when calculating this limit. The bill also prohibits plans from adjusting cost-sharing requirements based on the availability of cost-assistance programs for such medications. This directly affects patients using non-generic prescription drugs who would otherwise face unexpectedly high out-of-pocket expenses. The law applies to most health benefit plans starting August 28, 2026.

SB 1340 prevents health insurers and pharmacy benefit managers (PBMs) from discriminating against healthcare providers participating in the federal 340B drug program. It prohibits them from paying covered entities (like hospitals and clinics) less for 340B drugs than other pharmacies, imposing different fees or network restrictions, requiring identification of 340B drugs, or refusing coverage for these drugs. The law requires equal treatment in reimbursement and terms, with violations subject to $5,000 daily civil penalties. This directly affects 340B-covered entities and the insurers/PBMs that pay for their medications.

HB 1681 requires health insurance plans (health benefit plans) to include medication costs toward an enrollee's yearly out-of-pocket maximum when a generic drug alternative is unavailable for that medication. It prevents health carriers and pharmacy benefit managers from adjusting an enrollee's out-of-pocket costs or benefits based on the availability of cost-sharing assistance programs for non-generic medications. The bill applies to most health benefit plans starting August 28, 2026, and does not affect plans covered under the Labor Management Relations Act. This directly affects people enrolled in health insurance who need medications without generic options, ensuring these costs count toward their annual coverage limit.

HB 1680 requires health insurance plans to cover nonopioid medications equally to opioids for treating acute pain (short-term pain from injury or illness expected to last 30 days or less). It prohibits insurers from denying coverage for nonopioid drugs, forcing patients to try opioids first, or charging higher copays for nonopioid options compared to opioids. This directly affects health insurance plans and their enrollees (policyholders) who need pain treatment. The law applies to all health benefit plans issued or renewed on or after January 1, 2027. The bill aims to expand access to nonopioid pain management by removing financial and procedural barriers in insurance coverage.

HB 1850 updates Missouri's pharmacy auditing rules to protect pharmacies from unfair practices. It requires auditors (like insurance companies or pharmacy benefits managers) to give pharmacies 14 days' notice before on-site audits, involve licensed pharmacists for clinical reviews, and treat simple record-keeping mistakes as non-fraudulent. The bill allows pharmacies to correct minor errors within 30 days instead of facing penalties, and permits electronic prescriptions and digital records as valid proof. These changes directly affect Missouri-licensed pharmacies and the entities that audit their billing practices.

SB 1350 requires health insurance plans in Missouri to cover non-opioid medications for acute pain without restrictions, effective January 1, 2027. It directly affects enrollees (insurance policyholders) prescribed non-opioid drugs for pain expected to last 30 days or less. The bill prohibits insurers from denying coverage for these medications, forcing patients to try opioids first, or charging higher out-of-pocket costs for non-opioid drugs compared to opioids. This applies to all health benefit plans issued or renewed after the effective date, aiming to expand access to non-opioid pain treatment options.