MO SB674

Repeals section 354.535, RSMo and enacts two new sections (354.535 and 376.387) relating to health insurance and pharmacy services.

Pharmacists may take assignment of an enrollee's reimbursement rights when an HMO pharmacy is closed or unable to provide emergency services, and HMOs must pay pharmacists amounts due under policy terms.

HMOs must contract only with pharmacies and drug distributors that hold a permit or license from the Missouri Board of Pharmacy.

HMOs must apply uniform coinsurance, co-payment, and deductible factors to all participating pharmacy providers meeting explicit product cost determinations, though different factors may apply between generic and brand name drugs.

Enrollees pay only the usual and customary retail price when an HMO or health insurer's co-payment exceeds that price, with no additional charges to enrollee or plan sponsor.

HMOs cannot limit the quantity of drugs obtained per prescription unless the limit applies uniformly to all network pharmacy providers.

HMOs cannot mandate physicians or licensed practitioners to change an enrollee's maintenance drug (prescribed for more than 30 days) without provider and enrollee consent; violations subject to penalties in section 354.444 and HMOs liable for resulting damages.