Modifies provisions relating to the operation of, and investment of moneys by, certain hospitals
HB 2146 is a multi-part health care bill that revises several Missouri statutes affecting hospitals, hospital districts, pseudoephedrine sales, and 340B drug reimbursement. The bill expands investment authority for certain hospitals and hospital districts by allowing a larger share of idle funds to be placed in mutual funds, high-rated bonds, and money-market investments, while also tightening the conditions under which those investment powers apply based on the amount of tax support the hospital receives. It also updates hospital district powers and removes references to other hospital chapters in some cross-references, reflecting a broader cleanup of the statutory framework governing public and quasi-public hospitals.
The bill also makes significant changes to Missouri’s methamphetamine precursor drug laws. It raises the annual pseudoephedrine purchase limit from 43 grams to 61.2 grams, while leaving the 30-day and 24-hour limits in place, and it continues to require behind-the-counter sales, electronic logging, and reporting to the state. It adds a new manufacturer fee structure tied to the real-time pseudoephedrine tracking system beginning in 2026, and it creates or updates criminal penalties for violations, including a class A misdemeanor for unlawful sales, recordkeeping failures, underage sales, packaging violations, and failure to pay the required manufacturer fees.
A major new provision addresses 340B drug pricing. The bill prohibits health carriers, pharmacy benefit managers, and their affiliates from discriminating against covered entities that participate in the federal 340B program. It bars lower reimbursement, special fees or restrictions, refusal to cover 340B drugs, and certain claim-processing requirements that would treat covered entities differently because they dispense 340B drugs. The Department of Commerce and Insurance is directed to write rules and may impose civil penalties of up to $5,000 per violation per day for noncompliance.
The overall sentiment reflected in the voting history appears strongly favorable, with the House advancing the bill 143-1 on third reading. No committee transcript was provided, so there is no recorded debate to indicate detailed support or opposition. Based on the bill’s contents, the likely policy coalition includes hospitals and 340B covered entities supporting the measure, while potential concerns may come from pharmacy benefit managers, insurers, and opponents of loosening pseudoephedrine limits or expanding hospital investment authority.
The main points of contention are likely the increase in pseudoephedrine purchase thresholds, the new manufacturer fee requirement for the tracking system, and the 340B anti-discrimination rules affecting insurers and PBMs. The bill also changes the financial flexibility of certain hospitals and hospital districts, which may raise questions about public oversight, investment risk, and the role of local tax support in determining eligibility for those powers.
HB 2146 repeals and reenacts provisions in chapters governing hospitals, controlled substances, and insurance regulation. It expands the investment options and investment percentage limits for certain hospitals and hospital districts, modifies cross-references and operating authority for hospital entities, and adds a new section protecting 340B covered entities from discriminatory reimbursement and contracting practices by health carriers and pharmacy benefit managers. It also amends Missouri’s pseudoephedrine and ephedrine control laws by increasing annual purchase limits, establishing manufacturer fees for the tracking system, and updating criminal penalties for violations, thereby affecting hospitals, pharmacies, manufacturers, insurers, PBMs, and consumers purchasing methamphetamine precursor products.
The bill appears to have broad legislative support, as shown by the 143-1 House vote on third reading. No committee discussion was provided, so the record does not show detailed floor or committee debate. The bill’s structure suggests support from hospital interests and 340B providers, while the most likely skepticism would come from pharmacy benefit managers, insurers, and those concerned about relaxing pseudoephedrine controls or imposing new regulatory and fee burdens.
The most notable areas of contention are the increase in allowable pseudoephedrine purchases, the new monthly manufacturer fees tied to the pseudoephedrine tracking system, and the 340B provisions that restrict how insurers and PBMs can treat covered entities. Hospitals and hospital districts may favor the expanded investment authority, but taxpayers or local governments could question the reduced restrictions on public funds. Likewise, pharmacies and 340B covered entities are likely to support the anti-discrimination language, while health carriers and PBMs may object to the reimbursement and network requirements and the civil penalty exposure.