MO HB780

Requires pharmacy benefit managers (PBMs) to only include drugs on maximum allowable cost (MAC) lists that are FDA-approved as therapeutically equivalent, available from wholesalers in Missouri, and not obsolete or temporarily unavailable

Mandates PBMs provide contracted pharmacies access to current MAC lists and establish an appeal process allowing pharmacies to challenge reimbursement amounts within 30 days of a claim, with decisions required within 10 days

Requires PBMs to pay additional reimbursement at the next regular payment cycle if a pharmacy appeal is successful

Imposes fiduciary responsibility on PBMs to plan sponsors and requires disclosure when MAC lists differ between retail and mail-order pharmacies or when drug classifications differ from FDA definitions

Exempts the MO HealthNet program and authorizes the Department of Insurance to enforce violations under section 374.049