FIRST REGULAR SESSION
SENATE BILL NO. 187
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BERNSKOETTER.
0587S.01I KRISTINA MARTIN, Secretary
AN ACT
To amend chapter 376, RSMo, by adding thereto one new section relating to cost-sharing under
health benefit plans.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by a dding thereto 1
one new section, to be known as section 376.448, to read as 2
follows:3
376.448. 1. As used in this section, the following 1
terms mean: 2
(1) "Cost-sharing", any co-payment, coinsurance, 3
deductible, amount paid by an enrollee for he alth care 4
services in excess of a coverage limitation, or similar 5
charge required by or on behalf of an enrollee in order to 6
receive a specific health care service covered by a health 7
benefit plan, whether covered under medical benefits or 8
pharmacy benefits. The term "cost-sharing" shall include 9
cost-sharing as defined in 42 U.S.C. Section 18022(c); 10
(2) "Enrollee", the same meaning given to the term in 11
section 376.1350; 12
(3) "Health benefit plan", the same meaning given to 13
the term in section 376.1350; 14
(4) "Health care service", the same meaning given to 15
the term in section 376.1350; 16
(5) "Health carrier", the same meaning given to the 17
term in section 376.1350; 18 SB 187 2
(6) "Pharmacy benefits manager", the same meaning 19
given to the term in section 376.388. 20
2. When calculating an enrollee's overall contribution 21
to any out-of-pocket maximum or any cost -sharing requirement 22
under a health benefit plan, a health carrier or pharmacy 23
benefits manager shall include any amounts paid by the 24
enrollee or paid on behalf of the enrollee for any 25
medication where a generic substitute for said medication is 26
not available. 27
3. If, under federal law, application of the 28
requirement under subsection 2 of this section would result 29
in health savings account ineligibility under Section 223 of 30
the Internal Revenue Code of 1986, as amended, the 31
requirement under subsection 2 of this section shall apply 32
to health savings account -qualified high deductible health 33
plans with respect to a ny cost-sharing of such a plan after 34
the enrollee has satisfied the minimum deductible under 35
Section 223, except with respect to items or services that 36
are preventive care under Section 223(c)(2)(C) of the 37
Internal Revenue Code of 1986, as amended, in which case the 38
requirement of subsection 2 of this section shall apply 39
regardless of whether the minimum deductible under Section 40
223 has been satisfied. 41
4. Nothing in this section shall prohibit a health 42
carrier or health benefit plan from utili zing step therapy 43
pursuant to section 376.2034. 44