HB 2152 Summary

• Establishes requirements for pharmacy benefit managers (PBMs) placing drugs on maximum allowable cost (MAC) lists, including that drugs must be FDA-rated as therapeutically equivalent and available from national or regional wholesalers in Missouri.

• Requires PBMs to disclose to contracted pharmacies the pricing compendia and methodology used for MAC lists, provide prompt notification of updates, and update MAC lists within seven calendar days of methodology changes.

• Establishes an appeal process allowing pharmacies to challenge MAC prices within 60 days of initial claim, with PBMs required to investigate and resolve appeals within ten days.

• Requires PBMs to disclose to plan sponsors the basis for multi-source generic pricing lists and any differences in reimbursement rates or use of multiple pricing lists within contracted pharmacy networks.

• Imposes penalties on PBMs for non-compliance: $100 for first violation, $250 for second violation, and $1,000 for third and subsequent violations.