MO SB325

Pharmacy benefit managers (PBMs) must ensure drugs on maximum allowable cost (MAC) lists are FDA-approved as therapeutically equivalent, available from national or regional wholesalers in Missouri, and not obsolete or temporarily unavailable

PBMs must provide contracted pharmacies access to current MAC lists showing actual maximum allowable costs, and establish an appeal process for pharmacies to challenge reimbursement amounts within 30 days of initial claim

Appeals must be resolved within 10 days, and if additional reimbursement is determined necessary, payment must be made in the next regular payment cycle

PBMs must disclose to plan sponsors within 21 days if they use different MAC lists for retail versus mail-order pharmacies that result in higher costs, and must disclose any drugs they classify differently than the FDA

PBMs have fiduciary responsibility to plan sponsors, and noncompliance subjects them to penalties under section 374.049; the MO HealthNet program is exempt from these requirements