SB 840 creates a new section of Missouri law governing how cost-sharing is calculated under health benefit plans when a medication does not have a generic substitute. The bill requires health carriers and pharmacy benefits managers to count amounts paid by or on behalf of an enrollee for such medications toward the enrollee’s out-of-pocket maximum and other cost-sharing limits. It also prohibits carriers and PBMs from structuring benefits in a way that takes into account the availability of manufacturer or third-party cost-sharing assistance for those drugs.
The bill includes a special rule for health savings account-qualified high deductible health plans: if federal tax rules would make the new requirement incompatible with HSA eligibility, the mandate applies only after the enrollee meets the federal minimum deductible, except for preventive care items and services, which are covered regardless of deductible status. The bill preserves the use of step therapy and excludes plans covered by the federal Labor Management Relations Act. Its provisions would apply only to plans entered into, amended, extended, or renewed on or after August 28, 2026.
Impact
SB 840 would add section 376.448 to Missouri’s insurance code, directly affecting health carriers and pharmacy benefits managers that administer health benefit plans in the state. It would change how out-of-pocket maximums and cost-sharing accumulators are calculated for non-generic medications, potentially lowering enrollee costs and limiting the ability of plans to exclude manufacturer assistance from cost-sharing calculations. The bill would not apply to certain union-sponsored plans governed by federal labor law and would be phased in for new or renewed coverage beginning in 2026.
Sentiment
No committee transcripts or recorded votes were provided, so there is no documented debate or formal vote history to gauge support or opposition. Based on the bill’s structure, it appears aimed at consumer cost relief for patients using brand-name medications without generic substitutes, while also preserving insurer tools such as step therapy and accommodating federal HSA rules. The absence of recorded legislative action makes the overall sentiment unclear from the available materials.
Contention
The main policy tension is between lowering enrollee out-of-pocket costs and preserving insurer/PBM benefit design flexibility. Supporters would likely favor the bill for requiring assistance payments to count toward deductibles and out-of-pocket caps, especially for patients taking expensive drugs without generic alternatives. Potential opponents may object to the limits on benefit design and cost-sharing accumulation, particularly where manufacturer assistance programs are involved, though the bill attempts to address concerns by preserving step therapy, exempting ERISA/LMRA-covered plans, and delaying implementation until 2026.