MO SB895

Adds new section 376.388 to Missouri law establishing requirements for pharmacy benefit managers (PBMs) in setting maximum allowable cost (MAC) lists for drug reimbursement.

Requires drugs on MAC lists to be therapeutically equivalent and FDA-rated "A" or "B" in the Orange Book or Green Book, available for purchase from national or regional wholesalers in Missouri, and not obsolete or temporarily unavailable.

Mandates PBMs update MAC lists within seven calendar days of methodology changes, disclose pricing sources and methodologies to contracted pharmacies, and provide notification of updates to MAC lists.

Establishes a 60-day appeal window for pharmacies to challenge MAC pricing within three business days of claim fill date, with appeals investigated and resolved within ten days; allows retroactive reimbursements for one year from August 28, 2014.

Imposes civil penalties on non-compliant PBMs: $100 for first violation, $250 for second violation, and $1,000 for third and subsequent violations; exempts MO HealthNet program MAC lists from these requirements.