SB 512 - This act modifies provisions relating to payments for prescription drugs. FREEDOM OF CHOICE FOR PHARMACY SERVICES (Sections 338.015) The act specifies that certain provisions of law pertaining to pharmacists and pharmacies shall not be construed to prohibit patients' ability to obtain prescription services from any licensed pharmacist "or pharmacy", and repeals language specifying that the provisions do not remove patients' ability to waive their freedom of choice under a contract with regard to payment or coverage of prescription expenses. (Section 338.015.1). Under the act, no pharmacy benefits manager shall penalize or restrict a covered person from obtaining services from a contracted pharmacy, as such terms are defined by law. (Section 338.015.4). These provisions are identical to provisions in HB 474 (2025), and substantially similar to provisions in SB 45 (2025), SB 372 (2025), SB 1105 (2024), SB 843 (2024), SB 1213 (2024), HB 1627 (2024), SB 402 (2023), HB 197 (2023), SB 921 (2022), and HCS/HB 1677 (2022), and similar to provisions in HCS/HBs 982 & 840 (2025). PHARMACY BENEFITS MANAGERS (Section 376.387 and 376.388) Additionally, the act modifies the applicable definition of "covered person" for purposes of certain statutes governing pharmacy benefits managers ("PBMs") (Section 376.387.1(1)), modifies the maximum payment at the point of sale a covered person can be required to make (Section 376.381.2), and specifies that a pharmacy or pharmacist may provide to a health benefit plan sponsor any pharmacy claims data or any information related to the sponsor's plan unless otherwise prohibited by law (Section 376.387.3(2)). A PBM shall not reduce the amount of a claim at or after the time of a claim's adjudication, or charge the pharmacy a fee related to adjudication of a claim. (Section 376.387.4). The act also repeals a provision of law allowing PBMs to hold pharmacists or pharmacies responsible for fees related to charges for administering a health benefit plan (Section 376.387.5), and repeals a provision of law specifying that certain PBM regulations shall not apply with regard to Medicare Part D or other health plans regulated under federal law. (Former section 376.387.5). The act provides standardized definitions for the terms "generic" and "rebate" applicable to PBMs and health carriers (Section 376.387.7-8), and specifies that PBMs shall owe a fiduciary duty and duty of disclosure to the entities with which it contracts. (Section 376.387.9-10). No entity contracting to sell, provide, pay, or reimburse pharmacies for prescription drugs shall prohibit a health benefit plan sponsor and a contracted pharmacy from discussing any health benefit plan information, pharmacy claims data, or costs. (Section 376.387.11). PBMs shall not charge a health benefit plan or payer different amounts for drugs' ingredient costs or dispensing fees than it reimburses the pharmacy if the PBM retains the difference. (Section 376.387.12). The act repeals a portion of a definition to specify that certain provisions relating to the maximum allowable cost of a prescription drug are applicable to all pharmacies, rather than only to contracted pharmacies (Section 376.388.1(1)), and modifies the applicable definition of PBM to refer to any entity that contracts with a health carrier or health benefit plan to provide prescription drug or pharmacist services. (Section 376.388.1(5)). If the reimbursement for a drug to a contracted pharmacy is below the pharmacy's cost to purchase the drug, the pharmacy may decline to dispense the prescription, and the PBM shall not retaliate against the pharmacy for doing so. (Section 376.388.5(2)). Furthermore, the act regulates reimbursements and payments to pharmacies by PBMs as outlined in the act. (Section 376.388.5(3)). These provisions are identical to provisions in HB 474 (2025), and similar to provisions in SB 45 (2025), SB 372 (2025), HCS/HBs 982 & 840 (2025), SB 1105 (2024), SB 843 (2024), SB 1213 (2024), HB 1627 (2024), SB 402 (2023), HB 197 (2023), SB 921 (2022), and HCS/HB 1677 (2022). COST-SHARING UNDER HEALTH BENEFIT PLANS (Section 376.448) 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. These provisions are identical to provisions in HB 474 (2025) and HCS/HBs 982 & 840 (2025), and similar to provisions in SB 45 (2025), SB 187 (2025), HB 79 (2025), SB 1106 (2024), SB 844 (2024), SB 1190 (2024), HCS/HB 442 (2023), HB 1628 (2024), SB 269 (2023), and SB 1031 (2022). ERIC VANDER WEERD