HCSHB197--PAYMENTSFORPRESCRIPTIONDRUGS
SPONSOR: Wright
COMMITTEEACTION:Voted"DoPasswithHCS"bytheStanding
CommitteeonHealthandMentalHealthPolicybyavoteof11to3.
ThefollowingisasummaryoftheHouseCommitteeSubstituteforHB
197.
Thisbillisrelatedtopaymentsforprescriptiondrugs.Beginning
March1,2025,andannuallythereafter,apharmacybenefitsmanager
(PBM)utilizedbytheMissouriConsolidatedHealthCarePlanshall
fileareportwiththePlanfortheimmediatelyprecedingcalendar
yearregardingrebates,asdefinedinthebill.Thereportshall
include:
(1)Theaggregatedollaramountofrebatescollectedfrom
pharmaceutical manufacturers;
(2)Theaggregatedollaramountoftherebatesthatwerenot
passedontothePlan,and
(3)Theaggregatedollaramountofallfeesandpaymentsreceived
frompharmaceutical manufacturers.
ThePlanshallestablishaformforthereportingthatminimizes
administrative burdenandcost.Documents,materials,andother
informationsubmittedtothePlanshallnotbesubjectto
disclosureorcompromisethefinancial,competitive,orproprietary
natureoftheinformation,orallowathirdpartytoidentify
rebatevaluesforaparticularoutpatientprescriptiondrug,except
totheextenttheyarereportedintheaggregate. ThePlanshall
annuallyreporttotheGeneralAssemblytheaggregatedollaramount
ofpharmaceutical rebatesandprovideinformationdescribingthe
rebatepracticesofhealthcarriersutilizingpharmacybenefits
managers. ThePlanmayimposeapenaltyofupto$7,500onitsPBM
foreachviolationoftheseprovisions(Section103.200,RSMo).
Thebillspecifiesthatcertainprovisionsoflawpertainingto
pharmacistsandpharmaciesshallnotbeconstruedtoprohibit
patients'abilitytoobtainprescriptionservicesfromanylicensed
pharmacist"orpharmacy",andrepealslanguagespecifyingthatthe
provisionsdonotremovepatients'abilitytowaivetheirfreedom
ofchoiceunderacontractwithregardtopaymentorcoverageof
prescriptionexpensesandnoPBMshallpenalizeorrestricta
healthcarrierorenrolleesfromobtainingservicesfroma
contractedpharmacy(Section338.015). Additionally,thebillrepealsaprovisionoflawspecifyingthat
certainPBMregulationsshallnotapplywithregardtoMedicare
PartD,orotherhealthplansregulatedpartlyorwhollyunder
federallaw.Pharmacybenefitsmanagersshallnotifyhealth
carriersandpharmaciesinwritingofanypotentialconflictof
interest,includingbutnotlimitedtocommonownershiporany
otherrelationshipbetweenthePBMandanyotherhealthcarrieror
pharmacywithwhichthePBMcontracts. Thebillprovides
standardizeddefinitionsfortheterms"generic"and"rebate"
applicabletoPBMsandhealthcarriers,andspecifiesthatPBMs
shalloweafiduciarydutytothestateoranyhealthcarrier,
healthbenefitplan,orpoliticalsubdivisionwithwhichit
contracts(Section376.387).
Thebillrepealsaportionofadefinitiontospecifythatcertain
provisionsrelatingtothemaximumallowablecostofaprescription
drugareapplicabletoallpharmacies,ratherthanonlyto
contractedpharmacies. Ifthereimbursementforadrugtoa
contractedpharmacyisbelowthepharmacy'scosttopurchasethe
drug,thePBMshallsustainanappealandincreasereimbursement
forthepharmacyandothercontractedpharmaciestocoverthecost
ofpurchasingthedrug(Section376.388).
Thebillspecifiesthathealthcarriersorpharmacybenefits
managerscannotdiscriminateagainstacoveredentity,asdefined
inthePublicHealthServiceAct,orapharmacylicensedunder
Chapter338withwhichacoveredentityhascontractedtodispense
340Bdrugsonbehalfofthecoveredentity.TheDirectorofthe
DepartmentofCommerceandInsuranceshallenforcetheserulesand
imposeacivilpenaltythatshallnotexceed$5000perviolation
perdayonanypharmacybenefitsmanagerthatviolatesthese
provisions(Section376.414).
Thisbillrequiresthataninsurerprovidingcoveragefor
prescriptioninsulindrugsunderthetermsofahealthcoverage
planmustlimitthetotalamountthataninsuredpersonisrequired
topayfora30-daysupplyofacoveredprescriptioninsulindrug
tonomorethan$75.OnJanuary1ofeachyear,thelimitonthe
amountaninsuredpersonisrequiredtopayshallincreasebya
percentageequaltothepercentagechangefromtheprecedingyear
inthemedicalcarecomponentoftheConsumerPriceIndexfromthe
USDepartmentofLabor(Section376.687).
BeforeNovember2,2023,theDepartmentofCommerceandInsurance,
workinginconjunctionwiththeDepartmentofHealthandSenior
ServicesandtheDepartmentofSocialServices,shallmakeapublic
reportthatsummarizeseachdepartment'sfindingsrelatedto
insulinpricingpractices;publicpolicyrecommendations tocontrol
andpreventinsulindrugprescriptionoverpricing;andanyother informationthedepartmentsmaydeemnecessarytoinclude. The
provisionsofthisrequirementterminateJanuary1,2024(Section
376.689).
ThisbillissimilartoHB1677(2022).
Thefollowingisasummaryofthepublictestimonyfromthe
committeehearing. Thetestimonywasbasedontheintroduced
versionofthebill.
PROPONENTS: Supporterssaythatthisbillwouldincreaseaccessto
necessarymedicalcareforpersonsparticularlyinruralareasthat
maynotbeservicedbyalargepharmacychain.Inaddition,for
340Bdrugpricing,manysmall-businesspharmacyownersmustpick
whichlocationswouldcovertheir340Bdrugpricing. As
prescriptiondrugcostscontinuetorise,33statesandthelast
twopresidentialadministrations haveconductedinvestigations into
theefficacyofprogramssuchasthese,andtheirfindingssuggest
thatconsumerswillbeabletosavemorereadilyoncosts.
TestifyinginpersonforthebillwereRepresentative Wright;
UniversityofMissouriHealthCareSystem;EricaCrane;Jerry
Callahan;JoanTwiton,FordlandClinic;MissouriPharmacy
Association;KarenWhite,MoHighlandsHealth;LisaUmfleet;and
MissouriHospitalAssociation.
OPPONENTS: Thosewhoopposethebillsaythatthepharmacy
benefitsmanager,orPBM,istheonlystakeholderinthedrug
supplychainthatseekstoreducecosts;nooneismandatedtouse
aPBM.Opponentsalsoarguethatthisbillwilleliminatecost-
savingstools,raiseoverallcostsofmedicine,andremovethe
authorityofthePBMtomakedecisionsovercertainplanpolicies,
procedures,administrativefunctions,andsoon.Employersrelyon
PBMstohandlebusinessrelatingtopharmacycosts.
TestifyinginpersonagainstthebillwereAssociatedIndustriesof
Missouri;Cigna;St.LouisAreaBusinessHealthCoalition;Elevance
Health;MissouriChamberofCommerceandIndustry;NavitusHealth
Solutions;MissouriInsuranceCoalition;Mid-AmericaCarpenters
RegionalCouncil;Pharmaceutical CareManagementAssociation
(PCMA);America'sHealthInsPlans;andBlueCrossBlueShield.
Writtentestimonyhasbeensubmittedforthisbill.Thefull
writtentestimonyandwitnessestestifyingonlinecanbefound
underTestimonyonthebillpageontheHousewebsite.