MO SB236

Requires electronic prescription transmissions be sent directly to a pharmacist with no intervening access, include transmitter contact information and timestamp, and be transmitted by authorized practitioners or their designated agents.

Mandates electronic prescription devices allow any legal prescription to be written without interference and through a neutral platform that does not use advertising, messaging, or economic incentives to influence prescribing decisions at point of care.

Prohibits pharmacy benefits managers from automatically enrolling pharmacies in contracts, requiring participation in one contract to participate in another, or discriminating between in-network pharmacies based on copayments or days of supply without justification.

Establishes requirements for "switch communications" recommending medication changes, including disclosure of original and proposed medications, financial incentives to prescribers, clinical effects, cost sharing changes, and net cost impact to insurers; requires approval by Department of Insurance before distribution.

Sets maximum 14-day duration for step therapy or fail-first protocols (extendable seven additional days with clinical evidence), requires prescribers have access to clear override processes, and mandates PBMs maintain websites listing medications requiring preauthorization with compliance procedures.