MO HB1450

Requires electronic prescription transmissions to allow physicians to review patient medication lists, electronically adjudicate prior authorization and step therapy protocols within 48 hours, and minimize interference between physician and patient through neutral platforms.

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

Mandates that switch communications recommending medication changes include identification of original and proposed medications, explanation of financial incentives to prescribers, clinical effects, patient discussion rights, cost sharing changes, and net cost change to payers.

Requires health carriers and PBMs to submit switch communication formats to the Department of Insurance for approval and establishes penalties up to $25,000 for unapproved, false, or materially violating switch communications.

Grants prescribers access to clear processes to override step therapy or fail-first protocols when sound clinical evidence shows preferred treatment is ineffective or likely to cause harm, with duration limits of 14 days extendable to 21 days.