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