HB197--PAYMENTSFORPRESCRIPTIONDRUGS
SPONSOR:Wright
Thisbillisrelatedtopaymentsforprescriptiondrugs.BeginningMarch1,2025,andannually
thereafter,apharmacybenefitsmanager(PBM)utilizedbytheMissouriConsolidatedHealthCare
PlanshallfileareportwiththePlanfortheimmediatelyprecedingcalendaryearregardingrebates,
asdefinedinthebill.Thereportshallinclude:
(1)Theaggregatedollaramountofrebatescollectedfrompharmaceuticalmanufacturers;
(2)TheaggregatedollaramountoftherebatesthatwerenotpassedontothePlan,and
(3)Theaggregatedollaramountofallfeesandpaymentsreceivedfrompharmaceutical
manufacturers.
ThePlanshallestablishaformforthereportingthatminimizesadministrativeburdenandcost.
Documents,materials,andotherinformationsubmittedtothePlanshallnotbesubjectto
disclosureorcompromisethefinancial,competitive,orproprietarynatureoftheinformation,or
allowathirdpartytoidentifyrebatevaluesforaparticularoutpatientprescriptiondrug,exceptto
theextenttheyarereportedintheaggregate.ThePlanshallannuallyreporttotheGeneral
Assemblytheaggregatedollaramountofpharmaceuticalrebatesandprovideinformation
describingtherebatepracticesofhealthcarriersutilizingpharmacybenefitsmanagers.ThePlan
mayimposeapenaltyofupto$7,500onitsPBMforeachviolationoftheseprovisions(Section
103.200,RSMo).
Thebillspecifiesthatcertainprovisionsoflawpertainingtopharmacistsandpharmaciesshallnot
beconstruedtoprohibitpatients'abilitytoobtainprescriptionservicesfromanylicensed
pharmacist"orpharmacy",andrepealslanguagespecifyingthattheprovisionsdonotremove
patients'abilitytowaivetheirfreedomofchoiceunderacontractwithregardtopaymentor
coverageofprescriptionexpensesandnoPBMshallpenalizeorrestrictahealthcarrierorenrollees
fromobtainingservicesfromacontractedpharmacy(Section338.015).
Additionally,thebillrepealsaprovisionoflawspecifyingthatcertainPBMregulationsshallnot
applywithregardtoMedicarePartD,orotherhealthplansregulatedpartlyorwhollyunderfederal
law.Pharmacybenefitsmanagersshallnotifyhealthcarriersandpharmaciesinwritingofany
potentialconflictofinterest,includingbutnotlimitedtocommonownershiporanyother
relationshipbetweenthePBMandanyotherhealthcarrierorpharmacywithwhichthePBM
contracts.Thebillprovidesstandardizeddefinitionsfortheterms"generic"and"rebate"
applicabletoPBMsandhealthcarriers,andspecifiesthatPBMsshalloweafiduciarydutytothe
stateoranyhealthcarrier,healthbenefitplan,orpoliticalsubdivisionwithwhichitcontracts
(Section376.387).
Thebillrepealsaportionofadefinitiontospecifythatcertainprovisionsrelatingtothemaximum
allowablecostofaprescriptiondrugareapplicabletoallpharmacies,ratherthanonlyto
contractedpharmacies.Ifthereimbursementforadrugtoacontractedpharmacyisbelowthe pharmacy'scosttopurchasethedrug,thePBMshallsustainanappealandincrease
reimbursementforthepharmacyandothercontractedpharmaciestocoverthecostofpurchasing
thedrug(Section376.388).
Thebillspecifiesthathealthcarriersorpharmacybenefitsmanagerscannotdiscriminateagainsta
coveredentity,asdefinedinthePublicHealthServiceAct,orapharmacylicensedunderChapter
338withwhichacoveredentityhascontractedtodispense340Bdrugsonbehalfofthecovered
entity.TheDirectoroftheDepartmentofCommerceandInsuranceshallenforcetheserulesand
imposeacivilpenaltythatshallnotexceed$5000perviolationperdayonanypharmacybenefits
managerthatviolatestheseprovisions(Section376.414).
ThisbillissimilartoHB1677(2022).