Missouri legislation · 2026 Regular Session
Missouri SB970: Creates provisions relating to cost-sharing under health benefit plans
Status: In committee, May 15, 2026
SS/SCS/SB 970 - This act provides that when calculating an enrollee's overall contribution to an out-of-pocket max or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee for any medication for which a generic substitute is not available. Additionally, no health carrier or pharmacy benefits manager shall design benefits in a manner that takes into account the availability of any cost-sharing assistance program for any medication for which a generic drug substitute is not available. The provisions of this act shall apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026. This act is similar to HB 79 (2025) and substantially similar to provisions in SB 45 (2025), and similar to provisions in SB 187 (2025), SB 512 (2025), SB 1106 (2024), SB 844 (2024), SB 1190 (2024), HCS/HB 442 (2023), HB 1628 (2024), SB 269 (2023), and SB 1031 (2022). TAYLOR MIDDLETON
What the bill says
To amend chapter 376, RSMo, by adding thereto one new section relating to cost-sharing under health benefit plans. Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.448, to read as follows: 376.448. 1. As used in this section, the following terms mean: (1) "Cost-sharing", any co-payment, coinsurance, deductible, amount paid by an enrollee for health care services in excess of a coverage limitation, or similar charge required by or on behalf of an enrollee in order to receive a specific health care service covered by a health benefit plan, wh.
From the introduced text:
To amend chapter 376, RSMo, by adding thereto one new section relating to cost-sharing under health benefit plans. Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.448, to read as follows: 376.448. 1. As used in this section, the following terms mean: (1) "Cost-sharing", any co-payment, coinsurance, deductible, amount paid by an enrollee for health care services in excess of a coverage limitation, or similar charge required by or on behalf of an enrollee in order to receive a specific health care service covered by a health benefit plan, whether covered under medical benefits or pharmacy benefits. The term "cost-sharing" shall include cost-sharing as defined in 42 U.S.C. Section 18022(c); (2) "Enrollee", the same meaning given to the term in section 376.1350; (3) "Generic drug", the same meaning given to the term in 42 CFR 423.4; (4) "Health benefit plan", the same meaning given to the term in section 376.1350; SB 970 (5) "Health care service", the same meaning given to the term in section 376.1350; (6) "Health carrier", the same meaning given to the term in section 376.1350; (7) "Pharmacy benefits manager", the same meaning given to the term in section 376.388. 2. When calculating an enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a …