MO HB2279

Health carriers and pharmacy benefits managers must count payments made by or on behalf of enrollees toward out-of-pocket maximums and cost-sharing requirements for medications without generic substitutes available

Insurers are prohibited from varying cost-sharing requirements or designing benefits based on the availability of cost-sharing assistance programs (such as manufacturer coupons) for medications lacking generic alternatives

High deductible health plans compatible with health savings accounts are subject to these requirements only after enrollees meet the minimum IRS deductible, except for preventive care services

Health carriers may continue utilizing step therapy protocols as permitted under existing Missouri law (section 376.2034)

Applies to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026; excludes plans covered under the federal Labor Management Relations Act