| 1 | 1 | | FIRSTREGULARSESSION |
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| 2 | 2 | | HOUSEBILLNO.804 |
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| 3 | 3 | | 103RDGENERALASSEMBLY |
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| 4 | 4 | | INTRODUCEDBYREPRESENTATIVESTINNETT. |
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| 5 | 5 | | 1650H.01I JOSEPHENGLER,ChiefClerk |
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| 6 | 6 | | ANACT |
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| 7 | 7 | | Toamendchapter376,RSMo,byaddingtheretoonenewsectionrelatingtoinsurance |
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| 8 | 8 | | coverageofalternativestoopioiddrugs. |
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| 9 | 9 | | BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows: |
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| 10 | 10 | | SectionA.Chapter376,RSMo,isamendedbyaddingtheretoonenewsection,tobe |
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| 11 | 11 | | 2knownassection376.1280,toreadasfollows: |
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| 12 | 12 | | 376.1280.1.Asusedinthissection,thefollowingtermsmean: |
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| 13 | 13 | | 2 (1)"Elevatedriskofopioidmisuse",whenanenrolleemeetsoneormoreofthe |
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| 14 | 14 | | 3followingcriteria,asdeterminedbytheprescribinghealthcareprofessional: |
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| 15 | 15 | | 4 (a)Currentorprevioushistoryordiagnosisofasubstanceusedisorder; |
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| 16 | 16 | | 5 (b)Completedanadvancehealthcaredirectivetolimitpaincontrolto |
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| 17 | 17 | | 6nonopioidmeasuresasdescribedinsection459.016; |
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| 18 | 18 | | 7 (c)Increasedriskforopioidoverdose,dependency,orserioussideeffectsbased |
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| 19 | 19 | | 8onthepatient'sageordiagnosis;or |
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| 20 | 20 | | 9 (d)Currentlyprescribedmedicationswithcontraindicationsforopioiduse; |
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| 21 | 21 | | 10 (2)"Enrollee",thesamemeaninggiventotheterminsection376.1350; |
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| 22 | 22 | | 11 (3)"Healthbenefitplan",thesamemeaninggiventotheterminsection |
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| 23 | 23 | | 12376.1350; |
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| 24 | 24 | | 13 (4)"Healthcareprofessional",thesamemeaninggiventotheterminsection |
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| 25 | 25 | | 14376.1350. |
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| 26 | 26 | | 15 2.Notwithstandinganyprovisionoflawtothecontrary,whenalicensedhealth |
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| 27 | 27 | | 16careprofessionalactingwithinthescopeofhisorherlicenseprescribesanonopioid |
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| 28 | 28 | | EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis |
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| 29 | 29 | | intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17medicationforthetreatmentofpaintoapatientwithanelevatedriskofopioidmisuse, |
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| 30 | 30 | | 18itshallbeunlawfulforahealthbenefitplanto: |
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| 31 | 31 | | 19 (1)Denycoverageofthenonopioidprescriptiondruginfavorofanopioid |
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| 32 | 32 | | 20prescriptiondrug; |
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| 33 | 33 | | 21 (2)Requirethepatienttotryanopioidprescriptiondrugpriortoproviding |
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| 34 | 34 | | 22coverageofthenonopioidprescriptiondrug;or |
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| 35 | 35 | | 23 (3)Requireahigherlevelofcostsharingforthenonopioidprescriptiondrug |
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| 36 | 36 | | 24thanforanopioidprescriptiondrug. |
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| 37 | 37 | | 25 3.Nohealthbenefitplanshallrequireahealthcareprofessionalorenrolleeto |
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| 38 | 38 | | 26submitdocumentationbeyondtheprescribinghealthcareprofessional'sclinicalnotesto |
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| 39 | 39 | | 27determinewhetheranenrolleemeetsthecriteriaforanelevatedriskofopioidmisuse. |
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| 40 | 40 | | 28 4.Thissectionshallapplytohealthbenefitplansdelivered,issuedfordelivery, |
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| 41 | 41 | | 29continued,orrenewedonorafterJanuary1,2026. |
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| 42 | 42 | | âś” |
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| 43 | 43 | | HB804 2 |
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