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SECOND REGULAR SESSION
HOUSE BILL NO. 31 17
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE HEIN.
6910H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 376, RSMo, by adding thereto one new section relating to insurance
coverage for prescription insulin drugs.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be
2 known as section 376.389, to read as follows:
376.389 . 1. As used in this section, the following terms shall mean:
2 (1) "Cost-sharing", expenses imposed on an enr ollee for a cover ed health car e
3 service under the enrol lee's health benefit plan including, but not limited to, deductibles,
4 co-payments, and coinsurance;
5 (2) "Drug", the same meaning as is ascribed to such term in section 376.1350;
6 (3) "Enr ollee", the same meaning as is ascribed to such term in section 376.1350;
7 (4) "Health benefit plan", the same meaning as is ascribed to such term in
8 section 376.1350;
9 (5) "Health care service", the same meaning as is ascribed to such term in
10 section 376.1350;
11 (6) "Health carrier", the same meaning as is ascribed to such term in section
12 376.1350;
13 (7) "Pharmacy", the same meaning as is ascribed to such term in section
14 338.210;
15 (8) "Pr escription insulin drug", a drug that contains insulin and is used to
16 contr ol blood glucose levels to trea t diabetes, except that such term shall not include an
17 insulin drug that is administer ed to a patient intravenously;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
18 (9) "Rebate", any discount, negotiated concession, or other payment pr ovided
19 by a pharmaceutical manufactur er , pharmacy , or health benefit plan to an entity to sell,
20 pr ovide, pay , or reim burse a pharmacy or other entity in the state for the dispensing or
21 administration of drugs on behalf of itself or another entity;
22 (10) "T rade secr et", the same meaning as is ascribed to such term in section
23 417.453.
24 2. No health benefit plan that pr ovides coverage for pr escription insulin drugs
25 shall impose cost-sharing on an enrol lee in excess of thirty dollars per thirty-day supply
26 of a pr escription insulin drug.
27 3. (1) An enr ollee's cost-sharing for prescrip tion insulin drugs shall be
28 calculated at the point of sale based on a drug price that is red uced by an amount equal
29 to at least one hundre d per cent of all reba tes recei ved, or to be receive d, in connection
30 with the dispensing or administration of the drug.
31 (2) Nothing in this subsection shall pr ohibit a co-payment not calculated based
32 on drug price, pro vided that the co-payment does not exceed the r educed price of the
33 drug.
34 (3) Nothing in this subsection shall precl ude a health carrier fr om reduc ing a
35 cover ed individual's cost-sharing for a pr escription insulin drug by an amount great er
36 than that req uire d under this subsection.
37 (4) In complying with the pr ovisions of this subsection, no health carrier or its
38 agents shall be requi red to publish or otherwise r eveal information regar ding the actual
39 amount of re bates a health carrier r eceives on a pr oduct, manufactur er , or pharmacy-
40 specific basis. Such information shall be protect ed as a trade secr et, shall not be a public
41 r ecord under chapter 610, and shall not be disclosed dir ectly or indirect ly . A health
42 carrier shall impose the confidentiality protecti ons of this section on any vendor or other
43 third party that performs health care or administrative services on behalf of the health
44 carrier and that may rec eive or have access to r ebate information.
45 4. If any pr ovision of this section or the application ther eof to anyone or to any
46 cir cumstance is held invalid, the rem ainder of this section and the application of such
47 pr ovisions to others or other circu mstances shall not be affected ther eby .
48 5. This section shall apply to health benefit plans deliver ed, issued for delivery ,
49 continued, or renew ed on or after January 1, 2027.
✔
HB 31 17 2