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| 2 | 2 | | FIRST REGULAR SESSION |
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| 3 | 3 | | SENATE BILL NO. 187 |
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| 4 | 4 | | 103RD GENERAL ASSEMBLY |
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| 5 | 5 | | INTRODUCED BY SENATOR BERNSKOETTER. |
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| 6 | 6 | | 0587S.01I KRISTINA MARTIN, Secretary |
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| 7 | 7 | | AN ACT |
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| 8 | 8 | | To amend chapter 376, RSMo, by adding thereto one new section relating to cost-sharing under |
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| 9 | 9 | | health benefit plans. |
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| 10 | 10 | | |
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| 11 | 11 | | Be it enacted by the General Assembly of the State of Missouri, as follows: |
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| 12 | 12 | | Section A. Chapter 376, RSMo, is amended by a dding thereto 1 |
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| 13 | 13 | | one new section, to be known as section 376.448, to read as 2 |
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| 14 | 14 | | follows:3 |
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| 15 | 15 | | 376.448. 1. As used in this section, the following 1 |
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| 16 | 16 | | terms mean: 2 |
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| 17 | 17 | | (1) "Cost-sharing", any co-payment, coinsurance, 3 |
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| 18 | 18 | | deductible, amount paid by an enrollee for he alth care 4 |
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| 19 | 19 | | services in excess of a coverage limitation, or similar 5 |
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| 20 | 20 | | charge required by or on behalf of an enrollee in order to 6 |
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| 21 | 21 | | receive a specific health care service covered by a health 7 |
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| 22 | 22 | | benefit plan, whether covered under medical benefits or 8 |
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| 23 | 23 | | pharmacy benefits. The term "cost-sharing" shall include 9 |
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| 24 | 24 | | cost-sharing as defined in 42 U.S.C. Section 18022(c); 10 |
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| 25 | 25 | | (2) "Enrollee", the same meaning given to the term in 11 |
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| 26 | 26 | | section 376.1350; 12 |
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| 27 | 27 | | (3) "Health benefit plan", the same meaning given to 13 |
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| 28 | 28 | | the term in section 376.1350; 14 |
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| 29 | 29 | | (4) "Health care service", the same meaning given to 15 |
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| 30 | 30 | | the term in section 376.1350; 16 |
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| 31 | 31 | | (5) "Health carrier", the same meaning given to the 17 |
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| 32 | 32 | | term in section 376.1350; 18 SB 187 2 |
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| 33 | 33 | | (6) "Pharmacy benefits manager", the same meaning 19 |
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| 34 | 34 | | given to the term in section 376.388. 20 |
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| 35 | 35 | | 2. When calculating an enrollee's overall contribution 21 |
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| 36 | 36 | | to any out-of-pocket maximum or any cost -sharing requirement 22 |
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| 37 | 37 | | under a health benefit plan, a health carrier or pharmacy 23 |
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| 38 | 38 | | benefits manager shall include any amounts paid by the 24 |
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| 39 | 39 | | enrollee or paid on behalf of the enrollee for any 25 |
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| 40 | 40 | | medication where a generic substitute for said medication is 26 |
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| 41 | 41 | | not available. 27 |
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| 42 | 42 | | 3. If, under federal law, application of the 28 |
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| 43 | 43 | | requirement under subsection 2 of this section would result 29 |
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| 44 | 44 | | in health savings account ineligibility under Section 223 of 30 |
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| 45 | 45 | | the Internal Revenue Code of 1986, as amended, the 31 |
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| 46 | 46 | | requirement under subsection 2 of this section shall apply 32 |
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| 47 | 47 | | to health savings account -qualified high deductible health 33 |
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| 48 | 48 | | plans with respect to a ny cost-sharing of such a plan after 34 |
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| 49 | 49 | | the enrollee has satisfied the minimum deductible under 35 |
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| 50 | 50 | | Section 223, except with respect to items or services that 36 |
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| 51 | 51 | | are preventive care under Section 223(c)(2)(C) of the 37 |
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| 52 | 52 | | Internal Revenue Code of 1986, as amended, in which case the 38 |
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| 53 | 53 | | requirement of subsection 2 of this section shall apply 39 |
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| 54 | 54 | | regardless of whether the minimum deductible under Section 40 |
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| 55 | 55 | | 223 has been satisfied. 41 |
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| 56 | 56 | | 4. Nothing in this section shall prohibit a health 42 |
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| 57 | 57 | | carrier or health benefit plan from utili zing step therapy 43 |
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| 58 | 58 | | pursuant to section 376.2034. 44 |
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| 59 | 59 | | |
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