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SECOND REGULAR SESSION
SENATE BILL NO. 1156
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR NURRENBERN.
3850S.01I KRISTINA MARTIN, Secretary
AN ACT
To 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 1
one new section, to be known as section 376.389, to read as 2
follows:3
376.389. 1. As used in this section, the following 1
terms shall mean: 2
(1) "Cost-sharing", expenses imposed on an enrollee 3
for a covered health care service under the enrollee's 4
health benefit plan including, but not limited to, 5
deductibles, co-payments, and coinsurance; 6
(2) "Drug", the same meaning as is ascribed to such 7
term in section 376.1350; 8
(3) "Enrollee", the same meaning as is ascribed to 9
such term in section 376.1350; 10
(4) "Health benefit plan", the same meaning as is 11
ascribed to such term in section 376.1350; 12
(5) "Health care service", the same meaning as is 13
ascribed to such term in section 376.1350; 14
(6) "Health carrier", the same meaning as is ascribed 15
to such term in section 376.1350; 16
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(7) "Pharmacy", the same meaning as is ascribed to 17
such term in section 338.210; 18
(8) "Prescription insulin drug", a drug that contains 19
insulin and is used to control blood glucose levels to treat 20
diabetes, except that such term shall not include an insulin 21
drug that is administered to a patient intravenously; 22
(9) "Rebate", any discount, negotiated concession, or 23
other payment provided by a pharmaceutical manufacturer, 24
pharmacy, or health benefit plan to an entity to sell, 25
provide, pay, or reimburse a pharmacy or other entity in the 26
state for the dispensing or administration of drugs on 27
behalf of itself or another entity; 28
(10) "Trade secret", the same meaning as is ascribed 29
to such term in section 417.453. 30
2. No health benefit plan that provides coverage for 31
prescription insulin drugs shall impose cost-sharing on an 32
enrollee in excess of thirty dollars per thirty-day supply 33
of a prescription insulin drug. 34
3. (1) An enrollee's cost-sharing for prescription 35
insulin drugs shall be calculated at the point of sale based 36
on a drug price that is reduced by an amount equal to at 37
least one hundred percent of all rebates received, or to be 38
received, in connection with the dispensing or 39
administration of the drug. 40
(2) Nothing in this subsection shall prohibit a co- 41
payment not calculated based on drug price, provided that 42
the co-payment does not exceed the reduced price of the drug. 43
(3) Nothing in this subsection shall preclude a health 44
carrier from reducing a covered individual's cost-sharing 45
for a prescription insulin drug by an amount greater than 46
that required under this subsection. 47
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(4) In complying with the provisions of this 48
subsection, no health carrier or its agents shall be 49
required to publish or otherwise reveal information 50
regarding the actual amount of rebates a health carrier 51
receives on a product, manufacturer, or pharmacy-specific 52
basis. Such information shall be protected as a trade 53
secret, shall not be a public record under chapter 610, and 54
shall not be disclosed directly or indirectly. A health 55
carrier shall impose the confidentiality protections of this 56
section on any vendor or other third party that performs 57
health care or administrative services on behalf of the 58
health carrier and that may receive or have access to rebate 59
information. 60
4. If any provision of this section or the application 61
thereof to anyone or to any circumstance is held invalid, 62
the remainder of this section and the application of such 63
provisions to others or other circumstances shall not be 64
affected thereby. 65
5. This section shall apply to health benefit plans 66
delivered, issued for delivery, continued, or renewed on or 67
after January 1, 2027. 68
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