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 1833 allows active Missouri state employees eligible for the consolidated health care plan to opt out of state coverage and receive an annual stipend instead. Employees must provide proof of separate health insurance coverage and make the election within 31 days of hire or during designated open enrollment periods. The stipend equals 50% of the state’s contribution toward the employee’s health coverage (not including dependents), is taxable, and applies only to medical coverage (not dental/vision). This policy change directly affects state employees enrolled in the health plan who choose this alternative.
HB 2236 establishes Missouri's "Infertility Access Program" through the Department of Health and Senior Services to improve fertility treatment access. The program provides travel assistance, lodging stipends, or telehealth subsidies for individuals in rural or medically underserved areas seeking care at certified fertility clinics. It also creates an "Infertility Access Fund" for program administration, requires health carriers to publish clear fertility coverage summaries, and mandates annual reports on treatment utilization, geographic barriers, and demographic data. The bill directly affects patients in underserved regions, certified fertility clinics, and health insurance providers offering fertility coverage.
SB 929 requires health insurance plans to cover self-administered hormonal contraceptives (such as pills, patches, or rings) without cost-sharing, meaning no copays or deductibles. This directly affects individuals who use these contraceptives and their insurance providers. The key provision mandates that insurers include these specific methods in their coverage, aligning with broader contraceptive access standards. The bill focuses on eliminating financial barriers to commonly used, non-prescription-dependent birth control options.
HB 1875 requires health care providers in Missouri to notify patients before providing nonemergency care if they are out-of-network for the patient's health insurance plan. Before such care, providers must check the patient's insurance coverage and their own network status, and if out-of-network, they must inform the patient or the person consenting for the patient. This notification must occur prior to treatment and complements existing federal protections like the No Surprises Act. The bill directly affects health care providers and patients receiving nonemergency care in Missouri.
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.
SB 897 limits when health insurance companies can require prior authorization for medical services. It mandates that insurers must approve at least 90% of prior authorization requests from a provider for a specific service in the previous six-month period before requiring authorization. The bill also requires insurers to notify providers within 25 days of such determinations, establish appeal processes, and maintain an online portal for tracking authorization decisions. This primarily affects health insurance companies and healthcare providers in Missouri who participate in commercial health plans (excluding Medicaid managed care).
HB 1879 requires Missouri health insurance plans to cover genetic counseling and genetic testing for cancer risk starting January 1, 2027. It applies to individuals assessed as high-risk for harmful gene mutations based on personal or family cancer history. The law mandates that coverage includes all associated costs with no deductibles, copays, or other cost-sharing, and prohibits insurers from using genetic test results to deny coverage, adjust premiums, or limit benefits. This policy directly affects Missourians seeking cancer risk assessment and their health insurers.
HB 2582 requires applicants for Missouri's MO HealthNet program to verify they are not enrolled in another state's Medicaid program or a qualified health plan under the Affordable Care Act. It directly affects individuals seeking MO HealthNet benefits who currently have coverage elsewhere, including those relocating from other states. The bill mandates applicants provide a certificate of non-enrollment from their previous state program if applicable, and requires them to terminate that enrollment before MO HealthNet approval can be granted. This change adds a verification step to the application process without altering existing eligibility criteria for MO HealthNet.
