Missouri Senate Bill SB13

Missouri 2025 Regular Session

• Introduced: 1/8/25
• Refer: 1/16/25

Caption

Enacts provisions relating to insurance coverage of pharmacy services

Impact

The bill will modify existing insurance frameworks by explicitly prohibiting discriminatory practices that could limit access to drugs administered in clinician settings. It aims to create a level playing field among participating providers and pharmacies, ensuring that individuals can obtain their medications without the hindrance of potential extra fees or complications stemming from insurance coverage policies. By mandating that health carriers and pharmacy benefits managers cannot impose additional fees or co-payments for these necessary services, it seeks to lessen the financial burden on patients, particularly those needing critical treatments.

Summary

Senate Bill 13 aims to enhance the regulation of insurance coverage for pharmacy services within the state of Missouri. The bill introduces specific provisions that govern how health carriers and pharmacy benefits managers must handle clinician-administered drugs. One of the central tenets of the bill is the inclusion of protections against penalties or limitations on participating providers offering medically necessary drugs, irrespective of whether these are sourced from in-network providers. This move is designed to ensure greater accessibility and prompt provision of necessary medications to patients.

Contention

Despite its intended benefits, the bill has sparked discussions regarding its implications for pharmacy benefits managers and health carriers. Concerns have been raised about potential pushback from these entities regarding compliance costs and the administrative burden associated with conforming to the new regulations. Supporters argue that the bill's provisions are essential for patient care and equitable access to necessary pharmaceuticals, while critics warn of the challenges that may arise in its execution and its broader financial impacts on the healthcare industry.