Missouri Senate

House Committee Substitute

Additionally, all licensees, registrants, and permit holders shall report any surrender of a license or authorization to practice while under disciplinary investigation by another jurisdiction, and any exclusion to participate in any government funded health care program for fraud, abuse, or submission of any false claim, payment, or reimbursement request (338.075).

These provisions are substantially similar to the introduced version of SB 457 (2015).

The act provides that a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the prescriber, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90 day supply and the patient must have already been prescribed the medication for 3 months (338.202).

This provision is substantially similar to SCS/SB 973 (2016).

This act provides that the Board of Pharmacy shall not renew a nonresident pharmacy license if the applicant does not hold a current pharmacy license in the state in which the nonresident pharmacy is located (338.270).

Additionally, the Board shall not renew an out-of-state wholesale drug distributor, out-of-state pharmacy distributor, or drug distributor license if the applicant does not hold a current license in the state in which the distribution facility is located. If the applicant is a drug distributor registrant then the entity must be authorized and in good standing with the Food and Drug Administration or within the state where the facility is located in order for the Board to renew the registration (338.347).

These provisions are substantially similar to the perfected version of SB 458 (2015).

This act adds the U.S. Department of Health and Human Services to the list of entities with which the Director of the Department of Insurance, Financial Institutions, and Professional Registration may cooperate to regulate insurance and financial services (374.185).

This act requires a health carrier or managed care plan that provides prescription drug coverage in the state to offer medication synchronization services. A health carrier or managed care plan that provides prescription drug coverage shall not charge any amount in excess of the otherwise applicable co-payment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met (376.379).

This provision is substantially similar to SB 910 (2016) and is similar to SB 528 (2015), HB 198 (2015), and provisions in HCS/SB 458 (2015).

This act also requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing within seven days if the drugs do not meet the standards as provided in the act.

A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from at least one manufacturer and is generally available for purchase from national or regional wholesalers.

All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list (376.388).

These provisions are substantially similar to SCS/SB 908 (2016) and to provisions in HCS/SB 458 (2015) and similar to SB 325 (2015) and SB 895 (2014).

The act creates the "Missouri Health Insurance Rate Transparency Act" to apply to health benefit plans, excluding large group market, long-term care, and Medicare supplemental plans, delivered, issued for delivery, continued, or renewed on or after January 1, 2018. Under this act, no health carrier shall deliver, issue for delivery, continue, or renew a health benefit plan until the rates for that plan have been filed with the Director of the Department of Insurance, Financial Institutions, and Professional Registration in the manner specified in the act. Rates shall be filed for excepted health benefits plans, as defined in the act, and grandfathered health benefit plans 30 days prior to use for informational purposes only. For all other plans, a health carrier may use rates on: (1) the date the Director determines such rates are reasonable, (2) the date the health carrier notifies the Director of its intent to use rates the Director has determined are unreasonable, or (3) 60 days after filing rates with the Director.

The Director shall determine by rule when rates filed by health carriers shall be made publicly available and shall provide a means by which the public can submit written comments concerning proposed rate increases. The Director shall review the proposed rate and accompanying documentation and determine whether the rate is reasonable or unreasonable. Within 60 days of rate filing, the Director shall provide the health carrier with written notice detailing whether the proposed rate is reasonable or unreasonable. If the Director deems the rate is unreasonable, the written notice shall specify the deficiencies and detailed reasons why the rate is excessive, inadequate, unfairly discriminatory, or unjustified. Within 30 days of receiving written notice that the proposed rate is unreasonable, the health carrier may amend its rate, request reconsideration, or implement the proposed rate. The health carrier shall notify the Director of its intention within 30 days of receipt of the written notice. If a health carrier implements a rate determined to be unreasonable, the Department shall make such determination public.

The Director shall publish final rates on the Department's website no earlier than 30 days prior to the first day of the annual open enrollment period in the individual market for the applicable calendar year (376.465).

The act also extends the sunset provision for coverage of early refills of prescription eye drops with the authorization of a health care provider from January 1, 2017, to January 1, 2020 (376.1237).

This provision is identical to SB 868 (2016).

The act defines "telehealth" or "telemedicine" as the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while such patient is at the originating site and the health care provider is at the distant site. A health carrier may reimburse a health care provider for telehealth services that utilize asynchronous store-and-forward technologies, as defined in the act (376.1900).

These provisions are similar to provisions in SS/SB 621 (2016).

Finally, the act limits current law relating to small employer health benefit plans to only plans purchased on or before March 23, 2010 (379.934, 379.936, 379.938, 379.940).

JESSI BAKER