COMMITTEE ON LEGISLATIVE RESEARCH
OVERSIGHT DIVISION
FISCAL NOTE
L.R. No.:2109H.01I Bill No.:HB 840 Subject:Drugs and Controlled Substances; Pharmacy; Insurance - Health Type:Original Date:February 10, 2025Bill Summary:This proposal creates provisions relating to payments for prescription drugs.
FISCAL SUMMARY
ESTIMATED NET EFFECT ON GENERAL REVENUE FUNDFUND AFFECTEDFY 2026FY 2027FY 2028General Revenue
Fund*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
Total Estimated Net
Effect on General
Revenue$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Officials from the Missouri Consolidated Health Care Plan (MCHCP) state to the extent the
proposed language would not preclude MCHCP separately contracting with a specialty
pharmacy for supply and payment of specialty drugs, the expected fiscal impact would be $0.
However, should the language allow retail pharmacies to supply and bill for specialty drugs, then
MCHCP would likely have an unknown increase in cost of over $250,000. Oversight has
reflected a $0 or Unknown cost to various state and local funds that pay for health insurance.
ESTIMATED NET EFFECT ON OTHER STATE FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Other State Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)State Road Fund$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Conservation
Commission Fund$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
Total Estimated
Net Effect on Other
State Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
Numbers within parentheses: () indicate costs or losses. L.R. No. 2109H.01I
Bill No. HB 840
Page 2 of
February 10, 2025
KC:LR:OD
ESTIMATED NET EFFECT ON FEDERAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Federal Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)Total Estimated
Net Effect on All
Federal Funds$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
ESTIMATED NET EFFECT ON FULL TIME EQUIVALENT (FTE)FUND AFFECTEDFY 2026FY 2027FY 2028Total Estimated Net
Effect on FTE 000
☒ Estimated Net Effect (expenditures or reduced revenues) expected to exceed $250,000 in any
of the three fiscal years after implementation of the act or at full implementation of the act.
☐ Estimated Net Effect (savings or increased revenues) expected to exceed $250,000 in any of
the three fiscal years after implementation of the act or at full implementation of the act.
ESTIMATED NET EFFECT ON LOCAL FUNDSFUND AFFECTEDFY 2026FY 2027FY 2028Local Government*$0 to (Unknown)$0 to (Unknown)$0 to (Unknown)
*Officials from the Missouri Consolidated Health Care Plan (MCHCP) state to the extent the
proposed language would not preclude MCHCP separately contracting with a specialty
pharmacy for supply and payment of specialty drugs, the expected fiscal impact would be $0.
However, should the language allow retail pharmacies to supply and bill for specialty drugs, then
MCHCP would likely have an unknown increase in cost of over $250,000. Oversight has
reflected a $0 or Unknown cost to various state and local funds that pay for health insurance. L.R. No. 2109H.01I
Bill No. HB 840
Page 3 of
February 10, 2025
KC:LR:OD
FISCAL ANALYSIS
§§338.015 - 376.448 – Payments for Prescription Drugs
Officials from the Missouri Consolidated Health Care Plan (MCHCP) state to the extent the
proposed language would not preclude MCHCP separately contracting with a specialty
pharmacy for supply and payment of specialty drugs, the expected fiscal impact would be $0.
However, should the language allow retail pharmacies to supply and bill for specialty drugs, then
MCHCP would likely have an unknown increased cost of greater than $250,000.
Oversight will range the fiscal impact to MCHCP as $0 (the language would not preclude
MCHCP from separately contracting with a specialty pharmacy for supply and payment of
specialty drugs) to a negative Unknown (retail pharmacies are allowed to supply and bill for
specialty drugs) to the General Revenue Fund, Other State Funds, Federal Funds.
Officials from the Missouri Department of Transportation (MoDOT) assume the proposal
may increase costs for PBMs, which will likely pass on costs to the MoDOT-MSHP medical
plan. This would have an unknown negative impact to the State Road Fund.
Officials from the Missouri Department of Conservation assume the proposal will have no
fiscal impact on their organization.
Officials from Kansas City assume the proposed legislation has a negative fiscal impact of an
indeterminate amount.
Oversight notes although the Missouri Department of Conservation stated no impacted as a
result of this proposal, Oversight assumes this provision could have a fiscal impact MoDOT as
well as other government health plans. Since it is unknown if this legislation will increase costs
or not, Oversight will reflect a $0 to Unknown fiscal impact to the State Road Fund, the
Conservation Commission Fund and local political subdivisions.
Officials from the Office of Administration - Administrative Hearing Commission, the
Department of Commerce and Insurance and the Department of Social Services each
assume the proposal will have no fiscal impact on their respective organizations. Oversight does
not have any information to the contrary. Therefore, Oversight will reflect a zero impact in the
fiscal note for these agencies. L.R. No. 2109H.01I
Bill No. HB 840
Page 4 of
February 10, 2025
KC:LR:OD
Officials from the Department of Public Safety - Missouri Highway Patrol defer to the
MoDOT/MHP Health Care Board for response relating to the fiscal impact of this proposal on
their organization.
Oversight only reflects the responses received from state agencies and political subdivisions;
however, other cities were requested to respond to this proposed legislation but did not. A
general listing of political subdivisions included in the Missouri Legislative Information System
(MOLIS) database is available upon request.
FISCAL IMPACT – State GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028GENERAL REVENUE FUNDCost – MCHCP (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO THE
GENERAL REVENUE FUND
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
OTHER STATE FUNDSCost – MCHCP (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
OTHER STATE FUNDS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
STATE ROAD FUND (0320)Cost – MoDOT (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO THE
STATE ROAD FUND (0320)
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown) L.R. No. 2109H.01I
Bill No. HB 840
Page 5 of
February 10, 2025
KC:LR:OD
CONSERVATION COMMISSION
FUND (0609)
Cost – MoDOT (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO THE
CONSERVATION COMMISSION
FUND (0609)
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FEDERAL FUNDSCost – MCHCP (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
FISCAL IMPACT – Local GovernmentFY 2026
(10 Mo.)
FY 2027FY 2028*LOCAL POLITICAL
SUBDIVISIONS
Cost – (§§338.015 - 376.448)
Specialty Pharmacy for Specialty Drugs $0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
ESTIMATED NET EFFECT TO LOCAL
POLITICAL SUBDIVISIONS
$0 to
(Unknown)
$0 to
(Unknown)
$0 to
(Unknown)
*Officials from the Missouri Consolidated Health Care Plan (MCHCP) state to the extent the
proposed language would not preclude MCHCP separately contracting with a specialty
pharmacy for supply and payment of specialty drugs, the expected fiscal impact would be $0.
However, should the language allow retail pharmacies to supply and bill for specialty drugs, then
MCHCP would likely have an unknown increase in cost of over $250,000. Oversight has
reflected a $0 or Unknown cost to various state and local funds that pay for health insurance.
FISCAL IMPACT – Small Business
No direct fiscal impact to small businesses would be expected as a result of this proposal. L.R. No. 2109H.01I
Bill No. HB 840
Page 6 of
February 10, 2025
KC:LR:OD
FISCAL DESCRIPTION
The bill specifies that certain provisions of law pertaining to pharmacists and pharmacies must
not be construed to prohibit patients' ability to obtain prescription services from any licensed
pharmacist or pharmacy, and repeals language specifying that the provisions do not remove
patients' ability to waive their freedom of choice under a contract with regard to payment or
coverage of prescription expenses.
Additionally, no pharmacy benefits manager (PBM) can prohibit, penalize, or restrict a health
carrier or enrollees from obtaining services from a contracted pharmacy.
This bill prohibits PBMs from requiring a covered person to make a payment for a prescription
drug in an amount that exceeds the lesser of either the copay, the amount that would be paid if
cash were used, or the amount equal to the difference of the final reimbursement amount paid to
the pharmacy minus any rebate paid as well as any amount paid or owed by the health benefit
plan. The bill extends to pharmacies or pharmacists the rights to provide any information,
including pharmacy claims data, relating to a health benefit plan sponsor to such sponsor. It also
prohibits PBMs from reducing the amount of a claim at the time of its adjudication or after it has
been adjudicated, and prohibits PBMs from charging fees related to the adjudication of a claim.
Additionally, this bill repeals a provision of law specifying that certain PBM regulations will not
apply with regard to Medicare Part D, or other health plans regulated partly or wholly under
federal law.
It also requires PBMs entering into a contract to provide standardized definitions for the terms
"generic" and "rebate" applicable to PBMs and health carriers, and specifies that a PBM must
owe a fiduciary duty to the state or any health carrier, health benefit plan, or political subdivision
with which it contracts.
The bill adds that PBMs have a duty to disclose to a health benefit plan sponsor any material
facts and actions taken by the PBM relating to the administration of benefits on behalf of the
sponsor that may increase costs to the sponsor or its covered persons or that present a conflict of
interest between the interests of the sponsor and the interests of the PBM. Any entity that enters
into a contract to sell, provide, pay, or reimburse a pharmacy for prescription drugs on behalf of
itself or another entity is prohibited from prohibiting a health benefit plan sponsor and a
participating pharmacy from discussing any health benefit plan information. This bill makes it
unlawful for any PBM or any person acting on its behalf to charge a health benefit plan or payer
a different amount for a drug's ingredient cost or dispensing fee than the amount reimbursed to
the pharmacy by a PBM for the drug's ingredient cost or dispensing fee if the PBM retains any
amount of any such difference.
The bill repeals a portion of a definition to specify that certain provisions relating to the
maximum allowable cost of a prescription drug are applicable to all pharmacies, rather than only
to contracted pharmacies. If the reimbursement for a drug to a contracted pharmacy is below the L.R. No. 2109H.01I
Bill No. HB 840
Page 7 of
February 10, 2025
KC:LR:OD
pharmacy's cost to purchase the drug, the pharmacy may decline to dispense the prescription, and
a PBM cannot prohibit a pharmacy from doing so or retaliate after it has done so.
This bill prohibits PBMs from: (1) Paying or reimbursing a pharmacy in this state an amount that
is less than the amount that a PBM reimburses to a PBM affiliate, as that term is defined in the
bill, for providing the same costs and pharmacist services; (2) Paying or reimbursing a pharmacy
in the state for the ingredient drug product component of pharmacist services less than the
national or, as specified, the wholesale acquisition cost; (3) Making or permitting any reduction
of payment for pharmacist services by a PBM or health care payer to a pharmacy under a
reconciliation process; and (4) Removing from any pharmacy its legal right to civil recourse.
The bill provides that when calculating an enrollee's overall contribution to an out-of-pocket max
or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits
manager must include any amounts paid by the enrollee or paid on behalf of the enrollee only for
medication where a generic substitute is not available. PBMs and health carriers are prohibited
from varying an enrollee's out-of-pocket maximum, or any cost-sharing requirement, that is
based on or designed to take into account the availability of any cost-sharing assistance program
for any medication where a generic substitute is not available.
This legislation is not federally mandated, would not duplicate any other program and would not
require additional capital improvements or rental space.
SOURCES OF INFORMATION
Office of Administration - Administrative Hearing Commission
Department of Commerce and Insurance
Department of Public Safety - Missouri Highway Patrol
Department of Social Services
Missouri Department of Conservation
Missouri Department of Transportation
Kansas City
Missouri Consolidated Health Care Plan
Julie MorffJessica HarrisDirectorAssistant DirectorFebruary 10, 2025February 10, 2025