EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 372
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR MOON.
1062S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 338.015, 376.387, and 376.388, RSMo, and to enact in lieu thereof six new
sections relating to payments for prescription drugs, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 338.015, 376.387, and 376.388, RSMo, 1
are repealed and six new sections enacted in lieu thereof, to 2
be known as sections 103.200, 338.015, 376.387, 376.388, 3
376.416, and 376.2066, to read as follows:4
103.200. 1. For purposes of this section, the 1
following terms mean: 2
(1) "Pharmacy", the same meaning given to the term in 3
section 338.210; 4
(2) "Plan", the Missouri consolidated health care plan 5
as described in section 103.005; 6
(3) "Rebate", any discount, negotiated concession, or 7
other payment provided by a pharmaceutical manufacturer, 8
pharmacy, or health benefit plan to an entity to sell, 9
provide, pay, or reimburse a pharmacy or other entity in the 10
state for the dispensation or administration of a 11
prescription drug on behalf of itself or another entity. 12
2. Before March 1, 2027, and annually thereafter, the 13
pharmacy benefits manager utilized by the Missouri 14
consolidated health care plan shall file a report with the 15
plan for the immediately preceding calendar year. The 16 SB 372 2
report shall contain the following information regarding the 17
plan: 18
(1) The aggregate dollar amount of all rebates that 19
the pharmacy benefits manager collected from pharmaceutical 20
manufacturers that manufactured outpatient prescription 21
drugs that: 22
(a) Were covered by the plan during such calendar 23
year; and 24
(b) Were attributable to patient utilization of such 25
drugs during such calendar year; and 26
(2) The aggregate dollar amount of all rebates, 27
excluding any portion of the rebates received by the plan, 28
concerning drug formularies that the pharmacy benefits 29
manager collected from pha rmaceutical manufacturers that 30
manufactured outpatient prescription drugs that: 31
(a) Were covered by the plan during such calendar 32
year; and 33
(b) Were attributable to patient utilization of such 34
drugs by covered persons under the plan during s uch calendar 35
year. 36
3. In consultation with its pharmacy benefits manager, 37
the plan shall establish a form for reporting the 38
information required under subsection 2 of this section. 39
The form shall be designed to minimize the administrative 40
burden and cost of reporting on the plan and its pharmacy 41
benefits manager. 42
4. No documents, materials, or other information 43
submitted to the plan under subsection 2 of this section 44
shall be subject to disclosure under chapter 610, except to 45
the extent they are included on an aggregated basis in the 46
reports required under subsection 5 of this section. The 47 SB 372 3
plan shall not disclose information submitted under 48
subsection 2 of this section in a manner that: 49
(1) Is likely to compromise the financia l, 50
competitive, or proprietary nature of such information; or 51
(2) Would enable a third party to identify the value 52
of a rebate provided for a particular outpatient 53
prescription drug or therapeutic class of outpatient 54
prescription drugs. 55
5. (1) Before July 1, 2027, and annually thereafter, 56
the plan shall submit a report to the standing committees of 57
the general assembly having jurisdiction over health 58
insurance matters. The report shall contain an aggregation 59
of the information submitte d to the plan under subdivision 60
(1) of subsection 2 of this section for the immediately 61
preceding calendar year and such other information as the 62
plan in its discretion deems relevant for the purposes of 63
this section. The plan shall provide its pharma cy benefits 64
manager and any third party affected by submission of a 65
report required by this subsection with a written notice 66
describing the content of the report. 67
(2) Before July 1, 2027, and annually thereafter, the 68
plan shall prepare a report f or the immediately preceding 69
calendar year describing the rebate practices of the plan 70
and its pharmacy benefits manager. The plan shall provide 71
the report to the standing committees of the general 72
assembly having jurisdiction over health insurance ma tters 73
and the director of the department of commerce and 74
insurance. The report shall contain: 75
(a) An explanation of the manner in which the plan 76
accounted for rebates in calculating premiums for such year; 77 SB 372 4
(b) A statement disclosing whether , and describing the 78
manner in which, the plan made rebates available to 79
enrollees at the point of purchase during such year; 80
(c) A statement describing any other manner in which 81
the plan applied rebates during such year; and 82
(d) Such other information as the plan in its 83
discretion deems relevant for the purposes of this section. 84
6. The plan may impose a penalty of no more than seven 85
thousand five hundred dollars on its pharmacy benefits 86
manager for each violation of this section. 87
338.015. 1. The provisions of sections 338.010 to 1
338.015 shall not be construed to inhibit the patient's 2
freedom of choice to obtain prescription services from any 3
licensed pharmacist or pharmacy. [However, nothing in 4
sections 338.010 to 338.315 abrogates the patient's ability 5
to waive freedom of choice under any contract with regard to 6
payment or coverage of prescription expense. ] 7
2. All pharmacists may provide pharmaceutical 8
consultation and advice to persons concernin g the safe and 9
therapeutic use of their prescription drugs. 10
3. All patients shall have the right to receive a 11
written prescription from their prescriber to take to the 12
facility of their choice or to have an electronic 13
prescription transmitted to the facility of their choice. 14
4. No pharmacy benefits manager, as defined in section 15
376.388, shall prohibit or redirect by contract, or 16
otherwise penalize or restrict, a covered person, as defined 17
in section 376.387, from obtaining prescription s ervices, 18
consultation, or advice from a contracted pharmacy, as 19
defined in section 376.388. 20
376.387. 1. For purposes of this section, the 1
following terms shall mean: 2 SB 372 5
(1) "Covered person", [the same meaning as such term 3
is defined in section 376.1257 ] a policyholder, subscriber, 4
enrollee, or other individual who receives prescription drug 5
coverage through a pharmacy benefits manager ; 6
(2) "Health benefit plan", the same meaning as such 7
term is defined in section 376.135 0; 8
(3) "Health carrier" or "carrier", the same meaning as 9
such term is defined in section 376.1350; 10
(4) "Pharmacy", the same meaning as such term is 11
defined in chapter 338; 12
(5) "Pharmacy benefits manager", the same meaning as 13
such term is defined in section 376.388. 14
2. No pharmacy benefits manager shall include a 15
provision in a contract entered into or modified on or after 16
August 28, 2018, with a pharmacy or pharmacist that requires 17
a covered person to make a payment for a pres cription drug 18
at the point of sale in an amount that exceeds the lesser of: 19
(1) The copayment amount as required under the health 20
benefit plan; or 21
(2) The amount an individual would pay for a 22
prescription if that individual paid with cash. 23
3. A pharmacy or pharmacist shall have the right to 24
provide to a covered person information regarding the amount 25
of the covered person's cost share for a prescription drug, 26
the covered person's cost of an alternative drug, and the 27
covered person's cost of the drug without adjudicating the 28
claim through the pharmacy benefits manager. Neither a 29
pharmacy nor a pharmacist shall be proscribed by a pharmacy 30
benefits manager from discussing any such information or 31
from selling a more affordable alter native to the covered 32
person. 33 SB 372 6
4. No pharmacy benefits manager shall, directly or 34
indirectly, charge or hold a pharmacist or pharmacy 35
responsible for any fee amount related to a claim that is 36
not known at the time of the claim's adjudication, unle ss 37
the amount is a result of improperly paid claims [or charges 38
for administering a health benefit plan ]. 39
5. [This section shall not apply with respect to 40
claims under Medicare Part D, or any other plan administered 41
or regulated solely under fede ral law, and to the extent 42
this section may be preempted under the Employee Retirement 43
Income Security Act of 1974 for self -funded employer- 44
sponsored health benefit plans. 45
6.] A pharmacy benefits manager shall notify in 46
writing any health carrier with which it contracts if the 47
pharmacy benefits manager has a conflict of interest, any 48
commonality of ownership, or any other relationship, 49
financial or otherwise, between the pharmacy benefits 50
manager and any other health carrier with which the pha rmacy 51
benefits manager contracts. 52
[7.] 6. Any entity that enters into a contract to 53
sell, provide, pay, or reimburse a pharmacy in the state for 54
prescription drugs on behalf of itself or another entity 55
shall define and apply the term "generic", w ith respect to 56
prescription drugs, to mean any "authorized generic drug", 57
as defined in 21 CFR 314.3, approved under section 505(c) of 58
the Federal Food, Drug, and Cosmetic Act, as amended. 59
7. Any entity that enters into a contract to sell, 60
provide, pay, or reimburse a pharmacy in the state for 61
prescription drugs on behalf of itself or another entity 62
shall define and apply the term "rebate" as having the same 63
meaning given to the term in section 103.200. 64 SB 372 7
8. A pharmacy benefits manager that has contracted 65
with an entity to provide pharmacy benefit management 66
services for such an entity shall owe a fiduciary duty to 67
that entity, and shall discharge that duty in accordance 68
with federal and state law. 69
9. The department of commerce and insurance shall 70
enforce this section. 71
376.388. 1. As used in this section, unless the 1
context requires otherwise, the following terms shall mean: 2
(1) "Contracted pharmacy" [or "pharmacy"], a pharmacy 3
located in Missouri parti cipating in the network of a 4
pharmacy benefits manager through a direct or indirect 5
contract; 6
(2) ["Health carrier", an entity subject to the 7
insurance laws and regulations of this state that contracts 8
or offers to contract to provide, deliver, a rrange for, pay 9
for, or reimburse any of the costs of health care services, 10
including a sickness and accident insurance company, a 11
health maintenance organization, a nonprofit hospital and 12
health service corporation, or any other entity providing a 13
plan of health insurance, health benefits, or health 14
services, except that such plan shall not include any 15
coverage pursuant to a liability insurance policy, workers' 16
compensation insurance policy, or medical payments insurance 17
issued as a supplement to a liability policy; 18
(3)] "Maximum allowable cost", the per -unit amount 19
that a pharmacy benefits manager reimburses a pharmacist for 20
a prescription drug, excluding a dispensing or professional 21
fee; 22
[(4)] (3) "Maximum allowable cost list" or " MAC list", 23
a listing of drug products that meet the standard described 24
in this section; 25 SB 372 8
[(5)] (4) "Pharmacy", as such term is defined in 26
chapter 338; 27
[(6)] (5) "Pharmacy benefits manager", an entity that 28
[contracts with pharmacies on behalf of health carriers or 29
any health plan sponsored by the state or a political 30
subdivision of the state ] administers or manages a pharmacy 31
benefits plan or program; 32
(6) "Pharmacy benefits manager affiliate", a pharmacy 33
or pharmacist that directly o r indirectly, through one or 34
more intermediaries, owns or controls, is owned or 35
controlled by, or is under common ownership or control with 36
a pharmacy benefits manager; 37
(7) "Pharmacy benefits plan or program", a plan or 38
program that pays for, rei mburses, covers the cost of, or 39
otherwise provides for pharmacist services to individuals 40
who reside in or are employed in this state . 41
2. Upon each contract execution or renewal between a 42
pharmacy benefits manager and a pharmacy or between a 43
pharmacy benefits manager and a pharmacy's contracting 44
representative or agent, such as a pharmacy services 45
administrative organization, a pharmacy benefits manager 46
shall, with respect to such contract or renewal: 47
(1) Include in such contract or renew al the sources 48
utilized to determine maximum allowable cost and update such 49
pricing information at least every seven days; and 50
(2) Maintain a procedure to eliminate products from 51
the maximum allowable cost list of drugs subject to such 52
pricing or modify maximum allowable cost pricing at least 53
every seven days, if such drugs do not meet the standards 54
and requirements of this section, in order to remain 55
consistent with pricing changes in the marketplace. 56 SB 372 9
3. A pharmacy benefits manager shall reimburse 57
pharmacies for drugs subject to maximum allowable cost 58
pricing that has been updated to reflect market pricing at 59
least every seven days as set forth under subdivision (1) of 60
subsection 2 of this section. 61
4. A pharmacy benefits manager shall not place a drug 62
on a maximum allowable cost list unless there are at least 63
two therapeutically equivalent multisource generic drugs, or 64
at least one generic drug available from at least one 65
manufacturer, generally available for purchase by netw ork 66
pharmacies from national or regional wholesalers. 67
5. (1) All contracts between a pharmacy benefits 68
manager and a contracted pharmacy or between a pharmacy 69
benefits manager and a pharmacy's contracting representative 70
or agent, such as a pharm acy services administrative 71
organization, shall include a process to internally appeal, 72
investigate, and resolve disputes regarding maximum 73
allowable cost pricing. The process shall include the 74
following: 75
[(1)] (a) The right to appeal shall be l imited to 76
fourteen calendar days following the reimbursement of the 77
initial claim; and 78
[(2)] (b) A requirement that the pharmacy benefits 79
manager shall respond to an appeal described in this 80
subsection no later than fourteen calendar days after the 81
date the appeal was received by such pharmacy benefits 82
manager. 83
(2) If a reimbursement to a contracted pharmacy is 84
below the pharmacy's cost to purchase the drug, the pharmacy 85
benefits manager shall sustain an appeal and increase 86
reimbursement to the pharmacy and other contracted 87
pharmacies to cover the cost of purchasing the drug. 88 SB 372 10
(3) A pharmacy benefits manager shall not reimburse a 89
pharmacy or pharmacist in the state an amount less than the 90
amount that the pharmacy benefits manager reimburses a 91
pharmacy benefits manager affiliate for providing the same 92
pharmacist services. 93
6. For appeals that are denied, the pharmacy benefits 94
manager shall provide the reason for the denial and identify 95
the national drug code of a drug prod uct that may be 96
purchased by contracted pharmacies at a price at or below 97
the maximum allowable cost and, when applicable, may be 98
substituted lawfully. 99
7. If the appeal is successful, the pharmacy benefits 100
manager shall: 101
(1) Adjust the maximum allowable cost price that is 102
the subject of the appeal effective on the day after the 103
date the appeal is decided; 104
(2) Apply the adjusted maximum allowable cost price to 105
all similarly situated pharmacies as determined by the 106
pharmacy benefits manager; and 107
(3) Allow the pharmacy that succeeded in the appeal to 108
reverse and rebill the pharmacy benefits claim giving rise 109
to the appeal. 110
8. Appeals shall be upheld if: 111
(1) The pharmacy being reimbursed for the drug subject 112
to the maximum allowable cost pricing in question was not 113
reimbursed as required under subsection 3 of this section; or 114
(2) The drug subject to the maximum allowable cost 115
pricing in question does not meet the requirements set forth 116
under subsection 4 of this section. 117
376.416. 1. For purposes of this section, the 1
following terms mean: 2 SB 372 11
(1) "340B drug", the same meaning given to the term in 3
section 376.414; 4
(2) "Covered entity", the same meaning given to the 5
term in section 376.414; 6
(3) "Health carrier", the same meaning given to the 7
term in section 376.1350; 8
(4) "Pharmacy benefits manager", the same meaning 9
given to the term in section 376.388; 10
(5) "Specified pharmacy", a pharmacy licensed under 11
chapter 338 with which a covered entity has contracted to 12
dispense 340B drugs on behalf of the covered entity 13
regardless of whether the 340B drugs are distributed in 14
person or through the mail. 15
2. A health carrier or pharmacy benefits manager shall 16
not discriminate against a covered entity or a specified 17
pharmacy by doing any of the following: 18
(1) Reimbursing a covered entity or specified pharmacy 19
for a quantity of a 340B drug in an amount less than such 20
health carrier or pharmacy benefits mana ger would pay to any 21
other similarly situated pharmacy that is not a covered 22
entity or a specified pharmacy for such quantity of such 23
drug on the basis that the entity or pharmacy is a covered 24
entity or specified pharmacy or that the entity or pharmacy 25
dispenses 340B drugs; 26
(2) Imposing any terms or conditions on covered 27
entities or specified pharmacies that differ from such terms 28
or conditions applied to other similarly situated pharmacies 29
that are not covered entities or specified pharmacies on the 30
basis that the entity or pharmacy is a covered entity or 31
specified pharmacy or that the entity or pharmacy dispenses 32
340B drugs including, but not limited to, terms or 33
conditions with respect to any of the following: 34 SB 372 12
(a) Fees, chargebacks, clawbacks, adjustments, or 35
other assessments; 36
(b) Professional dispensing fees; 37
(c) Restrictions or requirements regarding 38
participation in standard or preferred pharmacy networks; 39
(d) Requirements relating to the frequency or scope o f 40
audits or to inventory management systems using generally 41
accepted accounting principles; and 42
(e) Any other restrictions, conditions, practices, or 43
policies that, as specified by the director of the 44
department of commerce and insurance, interfe re with the 45
ability of a covered entity to maximize the value of 46
discounts provided under 42 U.S.C. Section 256b; 47
(3) Interfering with an individual's choice to receive 48
a 340B drug from a covered entity or specified pharmacy, 49
whether in person or via direct delivery, mail, or other 50
form of shipment; 51
(4) Requiring a covered entity or specified pharmacy 52
to identify, either directly or through a third party, 340B 53
drugs; or 54
(5) Refusing to contract with a covered entity or 55
specified pharmacy for reasons other than those that apply 56
equally to entities or pharmacies that are not covered 57
entities or specified pharmacies, or on the basis that: 58
(a) The entity or pharmacy is a covered entity or a 59
specified pharmacy; or 60
(b) The entity or pharmacy is described in any of 61
subparagraphs (A) to (O) of 42 U.S.C. Section 256b(a)(4). 62
3. The director of the department of commerce and 63
insurance shall impose a civil penalty on any pharmacy 64
benefits manager that violates the require ments of this 65 SB 372 13
section. Such penalty shall not exceed five thousand 66
dollars per violation per day. 67
4. The director of the department of commerce and 68
insurance shall promulgate rules to implement the provisions 69
of this section. Any rule or portion of a rule, as that 70
term is defined in section 536.010, that is created under 71
the authority delegated in this section shall become 72
effective only if it complies with and is subject to all of 73
the provisions of chapter 536 and, if applicable, section 74
536.028. This section and chapter 536 are nonseverable and 75
if any of the powers vested with the general assembly 76
pursuant to chapter 536 to review, to delay the effective 77
date, or to disapprove and annul a rule are subsequently 78
held unconstitutional, t hen the grant of rulemaking 79
authority and any rule proposed or adopted after August 28, 80
2025, shall be invalid and void. 81
376.2066. 1. As used in this section, terms shall 1
have the meanings ascribed to them in section 376.1350, and 2
the term "rebate" shall mean any discount, negotiated 3
concession, or other payment provided by a pharmaceutical 4
manufacturer, pharmacy as defined in section 388.210, or 5
other entity in the state for the dispensation or 6
administration of a prescription drug on behalf of itself or 7
another entity. 8
2. No later than March 1, 2027, and annually 9
thereafter, each health carrier shall submit to the 10
department, in a form and manner prescribed by the 11
department, a written certification for the immediatel y 12
preceding calendar year certifying that the health carrier 13
accounted for all pharmaceutical rebates in calculating the 14
premium for health benefit plans the carrier delivered, 15 SB 372 14
issued for delivery, continued, or renewed in this state 16
during that calendar year. 17