HB 784 creates a new section of Missouri law governing payments and reimbursement practices for 340B drugs. The bill defines key terms such as “340B drug,” “covered entity,” “health carrier,” “pharmacy,” and “pharmacy benefits manager,” and then prohibits health carriers, PBMs, and their agents or affiliates from discriminating against covered entities because they participate in the federal 340B drug-pricing program or dispense 340B drugs. The bill is aimed at ensuring that covered entities are reimbursed and treated comparably to similarly situated non-covered pharmacies and entities.
The bill bars a range of practices, including paying covered entities less for 340B drugs than similarly situated pharmacies, imposing different fees or conditions, restricting network participation, requiring special identification of 340B drugs, refusing to cover drugs purchased through the 340B program, or forcing reverse/resubmit/clarify actions on 340B claims except in ordinary business circumstances or when required by federal law. It also directs the Missouri Department of Commerce and Insurance to adopt rules to implement the section and authorizes civil penalties of up to $5,000 per violation per day for noncompliance.
Impact
HB 784 would add section 376.417 to Missouri’s insurance and pharmacy-related statutes, expanding state regulation of reimbursement practices involving 340B drugs. It would directly affect health carriers, pharmacy benefits managers, and their affiliates by prohibiting discriminatory reimbursement and administrative practices toward covered entities, while giving the Department of Commerce and Insurance enforcement and rulemaking authority. The bill would also create a civil penalty framework for violations and incorporate state administrative rule procedures under chapter 536.
Sentiment
Based on the bill text and available context, the measure appears to be a pro-provider, pro-340B bill intended to protect hospitals, clinics, and other covered entities that rely on the federal 340B program. No committee transcript or vote record is available here, so there is no documented floor or committee debate to gauge broader legislative sentiment. The structure of the bill suggests support for preserving 340B savings and limiting PBM and insurer practices that could reduce those savings.
Contention
The main points of contention are likely to involve pharmacy benefits managers, health carriers, and insurers versus covered entities such as hospitals, clinics, and contract pharmacies. The bill specifically targets practices such as clawbacks, differential reimbursement, network restrictions, audit requirements, and claim reprocessing, which are common areas of dispute in 340B policy. Another likely issue is whether the bill intrudes on federal 340B administration or imposes compliance burdens and penalties on private payers beyond what is required under federal law.