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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
[TRULY AGREED TO AND FINALLY PASSED]
HOUSE COMMITTEE SUBSTITUTE FOR
SENATE SUBSTITUTE FOR
SENATE COMMITTEE SUBSTITUTE FOR
SENATE BILL NO. 878
103RD GENERAL ASSEMBLY
2026
5598H.07T
AN ACT
To repeal sections 195.417, 338.010, 338.012, and 579.060, RSMo, and to enact in lieu thereof ten
new sections relating to pharmaceutical drugs and devices, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 195.417, 338.010, 338.012, and 1
579.060, RSMo, are repealed and ten new sections enacted in 2
lieu thereof, to be known as sections 195.417, 338.010, 338.012, 3
338.206, 338.208, 338.312, 376.417, 376.1280, 376.1960, and 4
579.060, to read as follows:5
195.417. 1. The limits specified in this section 1
shall not apply to any quantity of such product, mixture, or 2
preparation which must be dispensed, sold, or distributed in 3
a pharmacy pursuant to a valid prescription. 4
2. Within any thirty-day period, no person shall sell, 5
dispense, or otherwise provide to the same individual, and 6
no person shall purchase, receive, or otherwise acquire more 7
than the following amount: any number of packages of any 8
drug product containing any detectable amount of ephedrine, 9
phenylpropanolamine, or pseudoephedrine, or any of their 10
salts or optical isomers, or salts of optical isomers, 11
either as: 12
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(1) The sole active ingredient; or 13
(2) One of the active ingredients of a combination 14
drug; or 15
(3) A combination of any of the products specified in 16
subdivisions (1) and (2) of this subsection; 17
in any total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions. 19
3. Within any twenty-four-hour period, no pharmacist, 20
intern pharmacist, or registered pharmacy technician shall 21
sell, dispense, or otherwise provide to the same individual, 22
and no person shall purchase, receive, or otherwise acquire 23
more than the following amount: any number of packages of 24
any drug product containing any detectable amount of 25
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 26
of their salts or optical isomers, or salts of optical 27
isomers, either as: 28
(1) The sole active ingredient; or 29
(2) One of the active ingredients of a combination 30
drug; or 31
(3) A combination of any of the products specified in 32
subdivisions (1) and (2) of this subsection; 33
in any total amount greater than three and six-tenths grams 34
without regard to the number of transactions. 35
4. Within any twelve-month period, no person shall 36
sell, dispense, or otherwise provide to the same individual, 37
and no person shall purchase, receive, or otherwise acquire 38
more than the following amount: any number of packages of 39
any drug product containing any detectable amount of 40
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 41
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of their salts or optical isomers, or salts of optical 42
isomers, either as: 43
(1) The sole active ingredient; or 44
(2) One of the active ingredients of a combination 45
drug; or 46
(3) A combination of any of the products specified in 47
subdivisions (1) and (2) of this subsection; 48
in any total amount greater than [forty-three] sixty-one and 49
two-tenths grams, without regard to the number of 50
transactions. 51
5. All packages of any compound, mixture, or 52
preparation containing any detectable quantity of ephedrine, 53
phenylpropanolamine, or pseudoephedrine, or any of their 54
salts or optical isomers, or salts of optical isomers, 55
except those that are excluded from Schedule V in subsection 56
17 or 18 of section 195.017, shall be offered for sale only 57
from behind a pharmacy counter where the public is not 58
permitted, and only by a registered pharmacist or registered 59
pharmacy technician under section 195.017. 60
6. Each pharmacy shall submit information regarding 61
sales of any compound, mixture, or preparation as specified 62
in this section in accordance with transmission methods and 63
frequency established by the department by regulation. 64
7. (1) As used in this subsection, "administrator of 65
the real-time electronic pseudoephedrine tracking system" 66
means the entity responsible for developing, implementing, 67
and maintaining the data collection system described in 19 68
CSR 30-1.074 or any successor regulation. 69
(2) Beginning October 1, 2026, and continuing 70
thereafter, any manufacturer of any compound, mixture, or 71
preparation specified in this section that is sold in or 72
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into the state shall, on a monthly basis, pay fees to the 73
administrator of the real-time electronic pseudoephedrine 74
tracking system. 75
(3) The administrator of the real-time electronic 76
pseudoephedrine tracking system shall be responsible for 77
setting the fee levels required under this subsection. 78
(4) Upon the request of the department of health and 79
senior services, any manufacturer required to pay fees under 80
this subsection shall provide written documentation 81
demonstrating that the manufacturer has paid such fees. 82
(5) The fees required under this subsection shall be 83
assessed against each manufacturer solely on the basis of 84
sales transactions involving that manufacturer's own 85
compounds, mixtures, or preparations sold in or into the 86
state. No manufacturer shall be assessed fees based upon 87
transactions attributable to the compounds, mixtures, or 88
preparations of any other manufacturer. 89
8. No prescription shall be required for the 90
dispensation, sale, or distribution of any drug product 91
containing any detectable amount of ephedrine, 92
phenylpropanolamine, or pseudoephedrine, or any of their 93
salts or optical isomers, or salts of optical isomers, in an 94
amount within the limits described in subsections 2, 3, and 95
4 of this section. The superintendent of the Missouri state 96
highway patrol shall report to the revisor of statutes and 97
the general assembly by February first when the statewide 98
number of methamphetamine laboratory seizure incidents 99
exceeds three hundred incidents in the previous calendar 100
year. The provisions of this subsection shall expire on 101
April first of the calendar year in which the revisor of 102
statutes receives such notification. 103
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[8.] 9. This section shall supersede and preempt any 104
local ordinances or regulations, including any ordinances or 105
regulations enacted by any political subdivision of the 106
state. This section shall not apply to the sale of any 107
animal feed products containing ephedrine or any naturally 108
occurring or herbal ephedra or extract of ephedra. 109
[9.] 10. Any local ordinances or regulations enacted 110
by any political subdivision of the state prior to August 111
28, 2020, requiring a prescription for the dispensation, 112
sale, or distribution of any drug product containing any 113
detectable amount of ephedrine, phenylpropanolamine, or 114
pseudoephedrine, or any of their salts or optical isomers, 115
or salts of optical isomers, in an amount within the limits 116
described in subsections 2, 3, and 4 of this section shall 117
be void and of no effect and no such political subdivision 118
shall maintain or enforce such ordinance or regulation. 119
[10.] 11. All logs, records, documents, and electronic 120
information maintained for the dispensing of these products 121
shall be open for inspection and copying by municipal, 122
county, and state or federal law enforcement officers whose 123
duty it is to enforce the controlled substances laws of this 124
state or the United States. 125
[11.] 12. All persons who dispense or offer for sale 126
pseudoephedrine and ephedrine products, except those that 127
are excluded from Schedule V in subsection 17 or 18 of 128
section 195.017, shall ensure that all such products are 129
located only behind a pharmacy counter where the public is 130
not permitted. 131
[12.] 13. The penalty for a knowing or reckless 132
violation of this section is found in section 579.060. 133
338.010. 1. The "practice of pharmacy" includes: 1
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(1) The interpretation, implementation, and evaluation 2
of medical prescription orders, including any legend drugs 3
under 21 U.S.C. Section 353, and the receipt, transmission, 4
or handling of such orders or facilitating the dispensing of 5
such orders; 6
(2) The designing, initiating, implementing, and 7
monitoring of a medication therapeutic plan in accordance 8
with the provisions of this section; 9
(3) The compounding, dispensing, labeling, and 10
administration of drugs and devices pursuant to medical 11
prescription orders; 12
(4) The ordering and administration of vaccines 13
approved or authorized by the U.S. Food and Drug 14
Administration, as of January 1, 2026, or thereafter, 15
excluding vaccines for cholera, monkeypox, Japanese 16
encephalitis, typhoid, rabies, yellow fever, tick-borne 17
encephalitis, anthrax, tuberculosis, dengue, Hib, polio, 18
rotavirus, smallpox, [and any vaccine approved after January 19
1, 2023] or any vaccine that is not jointly included by 20
joint rules promulgated by the board of pharmacy and the 21
state board of registration for the healing arts for 22
vaccines approved by the U.S. Food and Drug Administration 23
after January 1, 2026, to persons at least seven years of 24
age or the age recommended by the Centers for Disease 25
Control and Prevention, whichever is older, pursuant to 26
joint promulgation of rules established by the board of 27
pharmacy and the state board of registration for the healing 28
arts unless rules are established under a state of emergency 29
as described in section 44.100; 30
(5) The participation in drug selection according to 31
state law and participation in drug utilization reviews; 32
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(6) The proper and safe storage of drugs and devices 33
and the maintenance of proper records thereof; 34
(7) Consultation with patients and other health care 35
practitioners, and veterinarians and their clients about 36
legend drugs, about the safe and effective use of drugs and 37
devices; 38
(8) The prescribing and dispensing of any nicotine 39
replacement therapy product under section 338.665; 40
(9) The dispensing of HIV postexposure prophylaxis 41
pursuant to section 338.730; and 42
(10) The offering or performing of those acts, 43
services, operations, or transactions necessary in the 44
conduct, operation, management and control of a pharmacy. 45
2. No person shall engage in the practice of pharmacy 46
unless he or she is licensed under the provisions of this 47
chapter. 48
3. This chapter shall not be construed to prohibit the 49
use of auxiliary personnel under the direct supervision of a 50
pharmacist from assisting the pharmacist in any of his or 51
her duties. This assistance in no way is intended to 52
relieve the pharmacist from his or her responsibilities for 53
compliance with this chapter and he or she will be 54
responsible for the actions of the auxiliary personnel 55
acting in his or her assistance. 56
4. This chapter shall not be construed to prohibit or 57
interfere with any legally registered practitioner of 58
medicine, dentistry, or podiatry, or veterinary medicine 59
only for use in animals, or the practice of optometry in 60
accordance with and as provided in sections 195.070 and 61
336.220 in the compounding, administering, prescribing, or 62
dispensing of his or her own prescriptions. 63
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5. A pharmacist with a certificate of medication 64
therapeutic plan authority may provide medication therapy 65
services pursuant to a written protocol from a physician 66
licensed under chapter 334 to patients who have established 67
a physician-patient relationship, as described in 68
subdivision (1) of subsection 1 of section 191.1146, with 69
the protocol physician. The written protocol authorized by 70
this section shall come only from the physician and shall 71
not come from a nurse engaged in a collaborative practice 72
arrangement under section 334.104, or from a physician 73
assistant engaged in a collaborative practice arrangement 74
under section 334.735. 75
6. Nothing in this section shall be construed as to 76
prevent any person, firm or corporation from owning a 77
pharmacy regulated by sections 338.210 to 338.315, provided 78
that a licensed pharmacist is in charge of such pharmacy. 79
7. Nothing in this section shall be construed to apply 80
to or interfere with the sale of nonprescription drugs and 81
the ordinary household remedies and such drugs or medicines 82
as are normally sold by those engaged in the sale of general 83
merchandise. 84
8. No health carrier as defined in chapter 376 shall 85
require any physician with which they contract to enter into 86
a written protocol with a pharmacist for medication 87
therapeutic services. 88
9. This section shall not be construed to allow a 89
pharmacist to diagnose or independently prescribe 90
pharmaceuticals. 91
10. The state board of registration for the healing 92
arts, under section 334.125, and the state board of 93
pharmacy, under section 338.140, shall jointly promulgate 94
rules regulating the use of protocols for medication therapy 95
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services. Such rules shall require protocols to include 96
provisions allowing for timely communication between the 97
pharmacist and the protocol physician or similar body 98
authorized by this section, and any other patient protection 99
provisions deemed appropriate by both boards. In order to 100
take effect, such rules shall be approved by a majority vote 101
of a quorum of each board. Neither board shall separately 102
promulgate rules regulating the use of protocols for 103
medication therapy services. Any rule or portion of a rule, 104
as that term is defined in section 536.010, that is created 105
under the authority delegated in this section shall become 106
effective only if it complies with and is subject to all of 107
the provisions of chapter 536 and, if applicable, section 108
536.028. This section and chapter 536 are nonseverable and 109
if any of the powers vested with the general assembly 110
pursuant to chapter 536 to review, to delay the effective 111
date, or to disapprove and annul a rule are subsequently 112
held unconstitutional, then the grant of rulemaking 113
authority and any rule proposed or adopted after August 28, 114
2007, shall be invalid and void. 115
11. The state board of pharmacy may grant a 116
certificate of medication therapeutic plan authority to a 117
licensed pharmacist who submits proof of successful 118
completion of a board-approved course of academic clinical 119
study beyond a bachelor of science in pharmacy, including 120
but not limited to clinical assessment skills, from a 121
nationally accredited college or university, or a 122
certification of equivalence issued by a nationally 123
recognized professional organization and approved by the 124
board of pharmacy. 125
12. Any pharmacist who has received a certificate of 126
medication therapeutic plan authority may engage in the 127
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designing, initiating, implementing, and monitoring of a 128
medication therapeutic plan as defined by a written protocol 129
from a physician that may be specific to each patient for 130
care by a pharmacist. 131
13. Nothing in this section shall be construed to 132
allow a pharmacist to make a therapeutic substitution of a 133
pharmaceutical prescribed by a physician unless authorized 134
by the written protocol or the physician's prescription 135
order. 136
14. "Veterinarian", "doctor of veterinary medicine", 137
"practitioner of veterinary medicine", "DVM", "VMD", "BVSe", 138
"BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or an 139
equivalent title means a person who has received a doctor's 140
degree in veterinary medicine from an accredited school of 141
veterinary medicine or holds an Educational Commission for 142
Foreign Veterinary Graduates (EDFVG) certificate issued by 143
the American Veterinary Medical Association (AVMA). 144
15. In addition to other requirements established by 145
the joint promulgation of rules by the board of pharmacy and 146
the state board of registration for the healing arts: 147
(1) A pharmacist shall administer vaccines by protocol 148
in accordance with treatment guidelines established by the 149
Centers for Disease Control and Prevention (CDC); 150
(2) A pharmacist who is administering a vaccine shall 151
request a patient to remain in the pharmacy a safe amount of 152
time after administering the vaccine to observe any adverse 153
reactions. Such pharmacist shall have adopted emergency 154
treatment protocols. 155
16. In addition to other requirements by the board, a 156
pharmacist shall receive additional training as required by 157
the board and evidenced by receiving a certificate from the 158
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board upon completion, and shall display the certification 159
in his or her pharmacy where vaccines are delivered. 160
17. A pharmacist shall inform the patient that the 161
administration of a vaccine will be entered into the 162
ShowMeVax system, as administered by the department of 163
health and senior services. The patient shall attest to the 164
inclusion of such information in the system by signing a 165
form provided by the pharmacist. If the patient indicates 166
that he or she does not want such information entered into 167
the ShowMeVax system, the pharmacist shall provide a written 168
report within fourteen days of administration of a vaccine 169
to the patient's health care provider, if provided by the 170
patient, containing: 171
(1) The identity of the patient; 172
(2) The identity of the vaccine or vaccines 173
administered; 174
(3) The route of administration; 175
(4) The anatomic site of the administration; 176
(5) The dose administered; and 177
(6) The date of administration. 178
18. A pharmacist licensed under this chapter may order 179
and administer vaccines approved or authorized by the U.S. 180
Food and Drug Administration to address a public health 181
need, as lawfully authorized by the state or federal 182
government, or a department or agency thereof, during a 183
state or federally declared public health emergency. 184
338.012. 1. A pharmacist with a certificate of 1
medication therapeutic plan authority may provide influenza, 2
group A streptococcus, and COVID-19 medication therapy 3
services pursuant to [a statewide standing order issued by 4
the director or chief medical officer of the department of 5
health and senior services if that person is a licensed 6
HCS SS SCS SB 878 12
physician, or a licensed physician designated by the 7
department of health and senior services] rules established 8
by the board of pharmacy and the state board of registration 9
for the healing arts, as described in this section. 10
2. This section shall not be construed to allow a 11
pharmacist to diagnose or independently prescribe 12
pharmaceuticals. 13
3. The state board of registration for the healing 14
arts, pursuant to section 334.125, and the state board of 15
pharmacy, pursuant to section 338.140, shall jointly 16
promulgate rules to implement the provisions of this 17
section. Any rule or portion of a rule, as that term is 18
defined in section 536.010, that is created under the 19
authority delegated in this section shall become effective 20
only if it complies with and is subject to all of the 21
provisions of chapter 536 and, if applicable, section 22
536.028. This section and chapter 536 are nonseverable and 23
if any of the powers vested with the general assembly 24
pursuant to chapter 536 to review, to delay the effective 25
date, or to disapprove and annul a rule are subsequently 26
held unconstitutional, then the grant of rulemaking 27
authority and any rule proposed or adopted after August 28, 28
2023, shall be invalid and void. 29
338.206. 1. As used in this section, the term 1
"medical device" shall mean equipment that is furnished by a 2
supplier or a home health agency and meets the following 3
conditions: 4
(1) Is a device classified by the U.S. Food and Drug 5
Administration as a Class I or Class II device under 21 6
U.S.C. Section 360c and its implementing regulations under 7
21 CFR Parts 860 to 892; 8
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(2) Is primarily and customarily used to serve a 9
medical purpose; 10
(3) Generally is not useful to an individual in the 11
absence of an illness or injury; and 12
(4) Is appropriate for use in the home. 13
2. Notwithstanding any provision of this chapter to 14
the contrary, pharmacists may prescribe any medical devices 15
authorized by rule promulgated jointly by the state board of 16
registration for the healing arts and the board of pharmacy 17
in accordance with subsection 3 of this section. 18
3. The state board of registration for the healing 19
arts, pursuant to section 334.125, and the board of 20
pharmacy, pursuant to section 338.140, shall jointly 21
promulgate rules to implement the provisions of this 22
section. Such rules shall be written and effective within 23
six months of the effective date of this section. 24
4. Any rule or portion of a rule, as that term is 25
defined in section 536.010, that is created under the 26
authority delegated in this section shall become effective 27
only if it complies with and is subject to all of the 28
provisions of chapter 536 and, if applicable, section 29
536.028. This section and chapter 536 are nonseverable and 30
if any of the powers vested with the general assembly 31
pursuant to chapter 536 to review, to delay the effective 32
date, or to disapprove and annul a rule are subsequently 33
held unconstitutional, then the grant of rulemaking 34
authority and any rule proposed or adopted after August 28, 35
2026, shall be invalid and void. 36
338.208. Notwithstanding any other provision of law to 1
the contrary, a pharmacist may dispense ivermectin and 2
hydroxychloroquine to a person, without requiring a 3
prescription order from a licensed health care practitioner, 4
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upon the approval of a warning label for the use and 5
indication in accordance with any written, standardized 6
procedures or protocols for the pharmacist issued by the 7
board of pharmacy, including, if required, providing the 8
person with instructions on the proper use of ivermectin and 9
hydroxychloroquine. Any ivermectin or hydroxychloroquine 10
that is dispensed by a pharmacist without a prescription 11
shall be kept behind the counter or otherwise not available 12
for self-service or direct consumer access, be stored in a 13
secure area accessible only to pharmacy personnel, and be 14
dispensed only by a pharmacist or pharmacy technician under 15
a pharmacist's supervision. 16
338.312. 1. As used in this section, unless the 1
context requires otherwise, the following terms mean: 2
(1) "Declared state disaster or emergency", a disaster 3
or emergency event for which a governor's state of emergency 4
proclamation has been issued or that the President of the 5
United States has declared to be a major disaster or 6
emergency; 7
(2) "Disaster period", the period of time that begins 8
ten days before a governor's proclamation of a state of 9
emergency or the declaration by the President of the United 10
States of a major disaster or emergency, whichever occurs 11
first, and extending for a period of sixty calendar days 12
following the end of the period specified in the 13
proclamation or declaration or sixty calendar days from the 14
proclamation or declaration if no end is provided. The 15
governor may extend the disaster period as warranted; 16
(3) "Pharmacy", the same meaning given to the term in 17
section 338.210. 18
2. Notwithstanding any provision of law to contrary, 19
the board of pharmacy shall have the authority to waive 20
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compliance with any Missouri rules and regulations for a 21
licensed pharmacy that is domiciled or headquartered in this 22
state when such pharmacy is dispensing, shipping, or 23
delivering prescription drugs into another state or United 24
States territory that is experiencing a declared state 25
disaster or emergency, provided that: 26
(1) The pharmacy is a licensed pharmacy in good 27
standing under this chapter and is authorized to ship 28
prescription drugs into the state or territory in question; 29
(2) The pharmacy is responding to an active declared 30
state disaster or emergency; 31
(3) The pharmacy complies with all emergency rules and 32
regulations for pharmacies established by the state or 33
territory for the duration of the disaster period; 34
(4) The pharmacy complies with all applicable federal 35
laws and regulations; and 36
(5) The waiver applies only to prescription drugs 37
dispensed, shipped, or delivered to residents or health care 38
facilities located within the geographic area specified in 39
the declared state disaster or emergency. 40
3. The board of pharmacy may promulgate rules to 41
implement the provisions of this section. Any rule or 42
portion of a rule, as that term is defined in section 43
536.010, that is created under the authority delegated in 44
this section shall become effective only if it complies with 45
and is subject to all of the provisions of chapter 536 and, 46
if applicable, section 536.028. This section and chapter 47
536 are nonseverable and if any of the powers vested with 48
the general assembly pursuant to chapter 536 to review, to 49
delay the effective date, or to disapprove and annul a rule 50
are subsequently held unconstitutional, then the grant of 51
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rulemaking authority and any rule proposed or adopted after 52
August 28, 2026, shall be invalid and void. 53
376.417. 1. As used in this section, the following 1
terms mean: 2
(1) "340B drug", the same meaning given to the term in 3
section 376.414; 4
(2) "Covered entity", any entity described in 5
subparagraphs (A) to (K) of subsection (a)(4) of Section 6
340B of the Public Health Service Act, 42 U.S.C. Section 7
256b, including any pharmacy with which such entity has 8
contracted to dispense 340B drugs on behalf of the entity; 9
(3) "Health carrier", the same meaning given to the 10
term in section 376.1350; 11
(4) "Pharmacy", an entity licensed under chapter 338; 12
(5) "Pharmacy benefits manager", the same meaning 13
given to the term in section 376.388. 14
2. A health carrier, a pharmacy benefits manager, or 15
an agent or affiliate of such health carrier or pharmacy 16
benefits manager shall not discriminate against a covered 17
entity including, but not limited to, by doing any of the 18
following: 19
(1) Reimbursing a covered entity for a quantity of a 20
340B drug in an amount less than it would pay any other 21
similarly situated pharmacy or entity that is not a covered 22
entity for such quantity of such drug on the basis that the 23
covered entity is a covered entity or that the covered 24
entity dispenses 340B drugs. The director of the department 25
of commerce and insurance shall specify by rule the 26
circumstances under which a pharmacy or entity shall be 27
deemed a "similarly situated pharmacy or entity" for 28
purposes of this subdivision; 29
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(2) Imposing any terms or conditions on covered 30
entities that differ from such terms or conditions applied 31
to other similarly situated entities or pharmacies that are 32
not covered entities on the basis that the covered entity is 33
a covered entity or that the covered entity dispenses 340B 34
drugs including, but not limited to, terms or conditions 35
with respect to any of the following: 36
(a) Fees, chargebacks, clawbacks, adjustments, or 37
other assessments; 38
(b) Professional dispensing fees; 39
(c) Restrictions or requirements regarding 40
participation in standard or preferred pharmacy networks; 41
(d) Requirements relating to the frequency or scope of 42
audits or to inventory management systems using generally 43
accepted accounting principles; and 44
(e) Any other restrictions, conditions, practices, or 45
policies that, as specified by the director of the 46
department of commerce and insurance, interfere with the 47
ability of a covered entity to maximize the value of 48
discounts provided under 42 U.S.C. Section 256b; 49
(3) Discriminating in reimbursement to a covered 50
entity based on the determination or indication a drug is a 51
340B drug; 52
(4) Requiring a covered entity to identify, either 53
directly or through a third party, a 340B drug; 54
(5) Refusing to cover drugs purchased under the 340B 55
drug-pricing program; or 56
(6) Requiring a covered entity to reverse, resubmit, 57
or clarify a 340B drug-pricing claim after the initial 58
adjudication unless these actions are: 59
(a) In the normal course of pharmacy business and not 60
related to 340B drug pricing; or 61
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(b) Required by federal law. 62
3. The director of the department of commerce and 63
insurance shall impose a civil penalty on any health 64
carrier, pharmacy benefits manager, or agent or affiliate of 65
such health carrier or pharmacy benefits manager that 66
violates the requirements of this section. Such penalty 67
shall not exceed five thousand dollars per violation per day. 68
4. The director of the department of commerce and 69
insurance shall promulgate rules to implement the provisions 70
of this section. Any rule or portion of a rule, as that 71
term is defined in section 536.010, that is created under 72
the authority delegated in this section shall become 73
effective only if it complies with and is subject to all of 74
the provisions of chapter 536 and, if applicable, section 75
536.028. This section and chapter 536 are nonseverable and 76
if any of the powers vested with the general assembly 77
pursuant to chapter 536 to review, to delay the effective 78
date, or to disapprove and annul a rule are subsequently 79
held unconstitutional, then the grant of rulemaking 80
authority and any rule proposed or adopted after August 28, 81
2026, shall be invalid and void. 82
376.1280. 1. As used in this section, the following 1
terms mean: 2
(1) "Acute pain", pain that results from disease, 3
accidental or intentional trauma, or other causes, that a 4
health care provider reasonably expects to last thirty days 5
or fewer; 6
(2) "Chronic pain", pain that is a persistent and long- 7
lasting condition characterized by discomfort or pain that 8
lasts for more than twelve weeks, often persisting beyond 9
the expected healing time. It may result from various 10
HCS SS SCS SB 878 19
causes including, but not limited to, injury, surgery, nerve 11
damage, or underlying medical conditions; 12
(3) "Enrollee", the same meaning given to the term in 13
section 376.1350; 14
(4) "Health benefit plan", the same meaning given to 15
the term in section 376.1350; 16
(5) "Health care professional", the same meaning given 17
to the term in section 376.1350. 18
2. Notwithstanding any provision of law to the 19
contrary, when a licensed health care professional acting 20
within the scope of his or her license prescribes a 21
nonopioid medication for the treatment of acute or chronic 22
pain to an enrollee, it shall be unlawful for a health 23
benefit plan to: 24
(1) Deny coverage of the nonopioid prescription drug 25
in favor of an opioid prescription drug; 26
(2) Require the enrollee to try an opioid prescription 27
drug before providing coverage of the nonopioid prescription 28
drug; or 29
(3) Require a higher level of cost-sharing for the 30
nonopioid prescription drug than for an opioid prescription 31
drug. 32
3. This section shall apply to health benefit plans 33
delivered, issued for delivery, continued, or renewed on or 34
after January 1, 2027. 35
4. The provisions of this section related to the 36
treatment of acute pain shall be applicable only when 37
multiple nonopioid medications are approved by the U.S. Food 38
and Drug Administration and indicated for the treatment of 39
acute pain. 40
5. The provisions of this section related to the 41
treatment of chronic pain shall be applicable only when 42
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multiple nonopioid medications are approved by the U.S. Food 43
and Drug Administration and indicated for the treatment of 44
chronic pain. 45
376.1960. 1. This section shall be known and may be 1
cited as "Nora's Law". 2
2. As used in this section, the following terms mean: 3
(1) "Health benefit plan", the same meaning given to 4
the term in section 376.1350; 5
(2) "Home blood pressure monitoring device", a mobile 6
device that can be used to measure blood pressure, and that 7
is validated for clinical accuracy and device calibration; 8
(3) "Home blood pressure monitoring device services", 9
patient education and training services on the setup and use 10
of a home blood pressure monitoring device. 11
3. Health benefit plans delivered, issued for 12
delivery, continued or renewed in this state on or after 13
January 1, 2027, and providing for maternity benefits, shall 14
provide coverage for a prescribed home blood pressure 15
monitoring device and home blood pressure monitoring device 16
services for pregnant women or women within twelve months 17
postpartum when determined to be medically appropriate in 18
accordance with American College of Obstetricians and 19
Gynecologists guidelines. Home blood pressure monitoring 20
devices or home blood pressure monitoring device services 21
prescribed shall meet the requirements for medical necessity 22
only and can only be prescribed again if the condition being 23
monitored deteriorates as to necessitate another 24
prescription, or as necessary for subsequent pregnancies. 25
579.060. 1. A person commits the offense of unlawful 1
sale, distribution, or purchase of over-the-counter 2
methamphetamine precursor drugs if he or she knowingly: 3
HCS SS SCS SB 878 21
(1) Sells, distributes, dispenses, or otherwise 4
provides any number of packages of any drug product 5
containing detectable amounts of ephedrine, 6
phenylpropanolamine, or pseudoephedrine, or any of their 7
salts, optical isomers, or salts of optical isomers, in a 8
total amount greater than seven and two-tenths grams to the 9
same individual within a thirty-day period, unless the 10
amount is dispensed, sold, or distributed pursuant to a 11
valid prescription; or 12
(2) Purchases, receives, or otherwise acquires within 13
a thirty-day period any number of packages of any drug 14
product containing any detectable amount of ephedrine, 15
phenylpropanolamine, or pseudoephedrine, or any of their 16
salts or optical isomers, or salts of optical isomers in a 17
total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions, unless the 19
amount is purchased, received, or acquired pursuant to a 20
valid prescription; or 21
(3) Purchases, receives, or otherwise acquires within 22
a twenty-four-hour period any number of packages of any drug 23
product containing any detectable amount of ephedrine, 24
phenylpropanolamine, or pseudoephedrine, or any of their 25
salts or optical isomers, or salts of optical isomers in a 26
total amount greater than three and six-tenths grams, 27
without regard to the number of transactions, unless the 28
amount is purchased, received, or acquired pursuant to a 29
valid prescription; or 30
(4) Sells, distributes, dispenses, or otherwise 31
provides any number of packages of any drug product 32
containing detectable amounts of ephedrine, 33
phenylpropanolamine, or pseudoephedrine, or any of their 34
salts, optical isomers, or salts of optical isomers, in a 35
HCS SS SCS SB 878 22
total amount greater than [forty-three] sixty-one and two- 36
tenths grams to the same individual within a twelve-month 37
period, unless the amount is dispensed, sold, or distributed 38
pursuant to a valid prescription; or 39
(5) Purchases, receives, or otherwise acquires within 40
a twelve-month period any number of packages of any drug 41
product containing any detectable amount of ephedrine, 42
phenylpropanolamine, or pseudoephedrine, or any of their 43
salts or optical isomers, or salts of optical isomers in a 44
total amount greater than [forty-three] sixty-one and two- 45
tenths grams, without regard to the number of transactions, 46
unless the amount is purchased, received, or acquired 47
pursuant to a valid prescription; or 48
(6) Dispenses or offers drug products that are not 49
excluded from Schedule V in subsection 17 or 18 of section 50
195.017 and that contain detectable amounts of ephedrine, 51
phenylpropanolamine, or pseudoephedrine, or any of their 52
salts, optical isomers, or salts of optical isomers, without 53
ensuring that such products are located behind a pharmacy 54
counter where the public is not permitted and that such 55
products are dispensed by a registered pharmacist or 56
pharmacy technician under subsection 11 of section 195.017; 57
or 58
(7) Holds a retail sales license issued under chapter 59
144 and knowingly sells or dispenses packages that do not 60
conform to the packaging requirements of section 195.418. 61
2. A pharmacist, intern pharmacist, or registered 62
pharmacy technician commits the offense of unlawful sale, 63
distribution, or purchase of over-the-counter 64
methamphetamine precursor drugs if he or she knowingly: 65
(1) Sells, distributes, dispenses, or otherwise 66
provides any number of packages of any drug product 67
HCS SS SCS SB 878 23
containing detectable amounts of ephedrine, 68
phenylpropanolamine, or pseudoephedrine, or any of their 69
salts or optical isomers, or salts of optical isomers, in a 70
total amount greater than three and six-tenth grams to the 71
same individual within a twenty-four hour period, unless the 72
amount is dispensed, sold, or distributed pursuant to a 73
valid prescription; or 74
(2) Fails to submit information under subsection 13 of 75
section 195.017 and subsection 6 of section 195.417 about 76
the sales of any compound, mixture, or preparation of 77
products containing detectable amounts of ephedrine, 78
phenylpropanolamine, or pseudoephedrine, or any of their 79
salts, optical isomers, or salts of optical isomers, in 80
accordance with transmission methods and frequency 81
established by the department of health and senior services; 82
or 83
(3) Fails to implement and maintain an electronic log, 84
as required by subsection 12 of section 195.017, of each 85
transaction involving any detectable quantity of 86
pseudoephedrine, its salts, isomers, or salts of optical 87
isomers or ephedrine, its salts, optical isomers, or salts 88
of optical isomers; or 89
(4) Sells, distributes, dispenses or otherwise 90
provides to an individual under eighteen years of age 91
without a valid prescription any number of packages of any 92
drug product containing any detectable quantity of 93
pseudoephedrine, its salts, isomers, or salts of optical 94
isomers, or ephedrine, its salts or optical isomers, or 95
salts of optical isomers. 96
3. Any person who violates the packaging requirements 97
of section 195.418 and is considered the general owner or 98
operator of the outlet where ephedrine, pseudoephedrine, or 99
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phenylpropanolamine products are available for sale shall 100
not be penalized if he or she documents that an employee 101
training program was in place to provide the employee who 102
made the unlawful retail sale with information on the state 103
and federal regulations regarding ephedrine, 104
pseudoephedrine, or phenylpropanolamine. 105
4. A manufacturer commits the offense of unlawful 106
sale, distribution, or purchase of over-the-counter 107
methamphetamine precursor drugs if he or she knowingly fails 108
to pay the fees required under subsection 7 of section 109
195.417. 110
5. The offense of unlawful sale, distribution, or 111
purchase of over-the-counter methamphetamine precursor drugs 112
is a class A misdemeanor. 113
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