FIRSTREGULARSESSION
HOUSEBILLNO.79
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEHRUZA.
1047H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Toamendchapter376,RSMo,byaddingtheretoonenewsectionrelatingtocost-sharing
underhealthbenefitplans.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Chapter376,RSMo,isamendedbyaddingtheretoonenewsection,tobe
2knownassection376.448,toreadasfollows:
376.448.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Cost-sharing",anyco-payment,coinsurance,deductible,amountpaidby
3anenrolleeforhealthcareservicesinexcessofacoveragelimitation,orsimilarcharge
4requiredbyoronbehalfofanenrolleeinordertoreceiveaspecifichealthcareservice
5coveredbyahealthbenefitplan,whethercoveredundermedicalbenefitsorpharmacy
6benefits.Theterm"cost-sharing"shallincludecost-sharingasdefinedin42U.S.C.
7Section18022(c);
8 (2)"Enrollee",thesamemeaninggiventotheterminsection376.1350;
9 (3)"Genericdrug",thesamemeaninggiventothetermin42CFR423.4;
10 (4)"Healthbenefitplan",thesamemeaninggiventotheterminsection
11376.1350;
12 (5)"Healthcareservice",thesamemeaninggiventotheterminsection
13376.1350;
14 (6)"Healthcarrier",thesamemeaninggiventotheterminsection376.1350;
15 (7)"Pharmacybenefitsmanager",thesamemeaninggiventotheterminsection
16376.388.
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 2.Whencalculatinganenrollee'soverallcontributiontoanyout-of-pocket
18maximumoranycost-sharingrequirementunderahealthbenefitplan,ahealthcarrier
19orpharmacybenefitsmanagershallincludeanyamountspaidbytheenrolleeorpaid
20onbehalfoftheenrolleeforanymedicationwhereagenericdrugsubstituteforsuch
21medicationisnotavailable.
22 3.Ahealthcarrierorpharmacybenefitsmanagershallnotvaryanenrollee's
23out-of-pocketmaximumoranycost-sharingrequirementbasedon,orotherwisedesign
24benefitsinamannerthattakesintoaccount,theavailabilityofanycost-sharing
25assistanceprogramforanymedicationwhereagenericdrugsubstituteforsuch
26medicationisnotavailable.
27 4.If,underfederallaw,applicationoftherequirementundersubsection2ofthis
28sectionwouldresultinhealthsavingsaccountineligibilityunderSection223ofthe
29InternalRevenueCodeof1986,asamended,therequirementundersubsection2ofthis
30sectionshallapplytohealthsavingsaccount-qualifiedhighdeductiblehealthplanswith
31respecttoanycost-sharingofsuchaplanaftertheenrolleehassatisfiedtheminimum
32deductibleunderSection223,exceptwithrespecttoitemsorservicesthatare
33preventivecareunderSection223(c)(2)(C)oftheInternalRevenueCodeof1986,as
34amended,inwhichcasetherequirementofsubsection2ofthissectionshallapply
35regardlessofwhethertheminimumdeductibleunderSection223hasbeensatisfied.
36 5.Nothinginthissectionshallprohibitahealthcarrierorhealthbenefitplan
37fromutilizingsteptherapyinaccordancewithsection376.2034.
38 6.Theprovisionsofthissectionshallnotapplytohealthbenefitplansthatare
39coveredundertheLaborManagementRelationsActof1947,29U.S.C.Section141et
40seq.,asamended.
41 7.Theprovisionsofthissectionshallapplytohealthbenefitplansenteredinto,
42amended,extended,orrenewedonorafterAugust28,2025.
âś”
HB79 2