The bill proposes to repeal and replace section 376.387 of the Revised Statutes of Missouri, focusing on regulations surrounding payments for prescription drugs. It introduces a new definition for "covered person," specifying that it refers to individuals whose prescription drug coverage is managed by a pharmacy benefits manager or health benefit plan. Additionally, the bill establishes that pharmacy benefits managers cannot require covered persons to pay more for a prescription drug at the point of sale than the lesser of their copayment or the cash price for the drug. It also grants pharmacies the right to inform covered persons about their cost shares and alternative drug options without needing to adjudicate claims through the pharmacy benefits manager. Furthermore, the bill mandates that pharmacy benefits managers disclose any conflicts of interest to health carriers and outlines their duty to inform health benefit plan sponsors of material facts regarding the administration of pharmacy benefits. It prohibits any entity from restricting discussions between health benefit plan sponsors and participating pharmacies about health benefit plan information, including pharmacy claims data. The Department of Commerce and Insurance is designated to enforce these provisions, ensuring transparency and fairness in the management of prescription drug payments.

Statutes affected:
Introduced (6439H.01): 376.387