HCS/SS/SCS/SB 878 - This act modifies provisions relating to pharmaceutical drugs and devices. LIMITS ON SALE OF OVER-THE-COUNTER DRUGS (SECTIONS 195.417 AND 579.060) Currently, no person shall sell, dispense, or purchase, over a 12 month period, more than a total amount of 43.2 grams of certain meth precursors. This act increases the amount to 61.2 grams. Beginning October 1, 2026, any manufacturer of a meth precursor drug that is sold in or into this state shall pay a monthly fee to the administrator of the real-time electronic pseudoephedrine tracking system, as described in the act. The fee is set by the administrator. A manufacturer commits the offense of unlawful, sale, distribution, or purchase of over-the-counter methamphetamine precursor drugs if the manufacturer knowingly fails to pay the fees required by this act. This act is identical to provisions in the perfected HCS/HB 2372 (2026) and substantially similar to provisions in SB 1069 (2026), SB 726 (2025), HB 1036 (2025), provisions of HCS/SS/SB 7 (2025), SCS/SB 317 (2025), SCS/HCS/HB 943 (2025), SB 548 (2025), and SB 143 (2025). PRACTICE OF PHARMACY - VACCINES (SECTION 338.010) Currently, the practice of pharmacy includes the ordering and administration of vaccines approved or authorized by the FDA, but excludes certain vaccines and those vaccines approved after January 1, 2023. This act instead provides that the practice of pharmacy includes the ordering and administration of certain vaccines approved or authorized by the FDA as of January 1, 2026, but excludes certain vaccines and those vaccines approved by the FDA after January 1, 2026, that are not included by joint rules promulgated by the Board of Pharmacy and the State Board of Registration for the Healing Arts. This provision is substantially similar to a provision in the truly agreed to and finally passed HCS/SS#2/SB 1233 (2026), HB 1976 (2026), in the perfected HCS/HB 2372 (2026), and in the perfected HCS/HB 3009 (2026). MEDICATION THERAPEUTIC PLAN AUTHORITY (SECTION 338.012) Currently, a pharmacist with a certificate of medication therapeutic plan authority can provide certain medication therapy services if there is a statewide order issued by the Director or the Chief Medical Officer of the Department of Health and Senior Services if such person is a licensed physician or by a licensed physician designated by the Department. This act repeals this language and authorizes the provision of such medication therapy services pursuant to rules established by the Board of Pharmacy and the State Board of Registration for the Healing Arts. This provision is identical to a provision in the perfected HCS/HB 3009 (2026). MEDICAL DEVICE PRESCRIPTIONS (SECTION 338.206) This act authorizes pharmacists to prescribe medical devices, as defined in the act. The Board of Pharmacy and the State Board of Registration for the Healing Arts shall jointly promulgate rules to implement this provision within six months of the effective date of this act. This provision is substantially similar to a provision in the perfected HCS/HB 3009 (2026). DISPENSING OF IVERMECTIN & HYDROXYCHLOROQUINE (SECTION 338.208) Under this act, a pharmacist may dispense ivermectin and hydroxychloroquine to a person, without a prescription order, upon the approval of a warning label for the use and indication in accordance with any written, standardized procedures or protocols issued by the Board of Pharmacy. Any ivermectin or hydroxychloroquine that is dispensed by a pharmacist or by a pharmacy technician under a pharmacist's supervision without a prescription shall be kept behind the counter or otherwise not available in a self-service area and be stored in a secure area accessible only to pharmacy personnel. This provision is similar to a provision in the perfected HCS/HB 3009 (2026). PHARMACY EMERGENCY WAIVERS (SECTION 338.312) The Board of Pharmacy shall have the authority to waive compliance with any Missouri rule or regulation for pharmacies dispensing, shipping, or delivering prescription drugs into another state or United States territory that is experiencing a declared state disaster or emergency, provided that: (1) The pharmacy is a licensed pharmacy in good standing and is authorized to ship prescription drugs into such state or territory; (2) The pharmacy is responding to a declared state disaster or emergency; (3) The pharmacy complies with all emergency rules and regulations for pharmacies established by the state or territory for the duration of the disaster period; (4) The pharmacy complies with all applicable federal laws and regulations; and (5) The waiver applies only to prescription drugs dispensed, shipped, or delivered to residents or health care facilities located within the geographic area specified in the declared state disaster or emergency. This provision is identical to a provision in the truly agreed to and finally passed HCS/SS#2/SB 1233 (2026), in HCS/HB 2300 (2026), in the perfected HCS/HB 2372 (2026), and in SCS/HB 3009 (2026), and is similar to provision in SB 1640 (2026). 340B DRUGS (SECTION 376.417) Under this act, a health carrier, a pharmacy benefits manager, or an agent or affiliate of such, shall not discriminate against a covered entity, as defined in the act, including by reimbursing the covered entity for a quantity of a 340B drug in an amount less than it would pay similarly situated non-covered entities for such drugs, imposing different terms and conditions as compared to similarly situated entities, refusing to cover 340B drugs or discriminating in reimbursement for 340B drugs, and other situations described under this act. The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier, pharmacy benefits manager, or agent or affiliate of such, that violates this provision, not to exceed $5,000 per violation per day. This provision is identical to a provision in SS/SCS/SB 841 (2026), in HCS/SB 1019 (2026), SB 1340 (2026), in SCS/HB 2146 (2026), in SCS/HCS/HB 2372 (2026), SCS/HCS/HB 943 (2025) and HB 784 (2025). COVERAGE OF NONOPIOID PRESCRIPTION DRUGS (SECTION 376.1280) This provides that health benefit plans shall not deny coverage of a nonopioid prescription drug in favor of an opioid drug, require the enrollee to try an opioid drug before covering the nonopioid drug, or require a higher level of cost-sharing for a nonopioid prescription drug than for an opioid drug. This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027. This provision is identical to a provision in SS/SCS/SB 841 (2026) and is similar to SB 902 (2026), provisions in HCS/SB 1019 (2026) SB 1350 (2026), SB 1449 (2026), HB 1680 (2026), HB 1966 (2026), in SCS/HCS/HB 2372 (2026), HCS/SB 2642 (2026), SB 158 (2025), HB 804 (2025), and provisions in HCS/SS/SB 7 (2025). COVERAGE OF HOME BLOOD PRESSURE MONITORING DEVICES (SECTION 376.1960) This act provides that health benefit plans providing for maternity benefits shall provide coverage for a home blood pressure monitoring device and home blood pressure monitoring device services, as defined in the act, for pregnant and postpartum women when determined to be medically appropriate in accordance with American College of Obstetricians and Gynecologists guidelines. This act shall apply to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027. This provision contains provisions similar to SB 1089 (2026), provisions in HCS/HB 2371 (2026), in SB 539 (2025), and in HB 842 (2025). KATIE O'BRIEN