SB 968 repeals and reenacts Missouri statutes governing pharmacy benefit managers (PBMs) and pharmacy reimbursement. The bill preserves a patient’s ability to choose a pharmacy and states that patients may receive a written or electronic prescription to take to the pharmacy of their choice. It also prohibits PBMs from restricting pharmacy choice, imposing certain participation requirements beyond state licensure rules, or reimbursing below the most recently published National Average Drug Acquisition Cost (NADAC) for a drug when it is dispensed or administered.
The bill substantially revises the state’s maximum allowable cost (MAC) framework for generic drugs, medical products, and devices. It requires PBMs to disclose the sources used to set MAC pricing, update MAC information at least every seven days, maintain an internal appeal process for pharmacies, and provide reasons and drug-code information when appeals are denied. It also requires PBMs to reimburse pharmacies at the greater of MAC or NADAC, limits when a drug may be placed on a MAC list, and requires equal reimbursement for pharmacies and PBM affiliates for the same drug. In addition, the bill mandates a dispensing fee of at least 90% of the MO HealthNet professional dispensing fee.
In practical terms, the bill would affect PBMs, health carriers, pharmacies, pharmacists, and pharmacy services administrative organizations operating in Missouri. It would create new reimbursement standards and appeal rights, likely increasing transparency and potentially raising PBM payment obligations to pharmacies. It also expands statutory definitions of PBM-related terms and clarifies that PBM affiliates must be treated comparably in reimbursement.
Because there were no committee transcripts or recorded votes provided, the overall sentiment cannot be measured from legislative debate or roll calls. Based on the bill text alone, the measure appears strongly pro-pharmacy and pro-consumer choice, with an emphasis on reimbursement fairness and pricing transparency. The absence of recorded opposition or support in the provided materials means no direct sentiment from lawmakers can be inferred.
The main points of contention likely center on the bill’s impact on PBM business practices, drug pricing controls, and plan costs. Pharmacies and pharmacy advocates would likely support the bill’s reimbursement floors, appeal rights, and affiliate parity provisions, while PBMs and possibly health carriers may object to the administrative burden, reduced pricing flexibility, and higher reimbursement requirements. The most significant policy dispute is likely whether the bill appropriately protects pharmacies from underpayment or instead interferes with negotiated drug benefit pricing and network design.
SB 968 would amend Missouri law in chapters 338 and 376 by replacing existing PBM provisions with more detailed reimbursement, disclosure, and appeal requirements. It would require PBMs to update MAC pricing frequently, reimburse at least NADAC or MAC, pay a minimum dispensing fee tied to MO HealthNet, and treat affiliated and non-affiliated pharmacies comparably. The bill would also strengthen patient pharmacy-choice protections and limit PBM-imposed participation conditions beyond state licensure standards.
No committee discussion or vote history was provided, so there is no recorded legislative sentiment to summarize from debate or roll calls. On the face of the bill, the policy direction is favorable to pharmacies and patient choice, with the text emphasizing reimbursement fairness, transparency, and appeal rights. That suggests likely support from pharmacy stakeholders and likely resistance from PBMs and possibly insurers or plan administrators.
The likely controversy is over how much control PBMs should have over reimbursement rates, MAC lists, and network participation rules. Pharmacy stakeholders would favor the bill’s higher payment floors, seven-day MAC updates, and appeal protections, while PBMs and health carriers may argue that these requirements increase costs, reduce flexibility, and interfere with plan administration. Another likely point of dispute is the affiliate reimbursement parity rule, which could be viewed as preventing preferential treatment or, conversely, as limiting PBM contracting arrangements.