MO SB1327

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 brand-name medications that have no generic substitute available

Insurers are prohibited from adjusting out-of-pocket maximums or designing benefits based on the availability of manufacturer cost-sharing assistance programs for medications without generic alternatives

For HSA-qualified high deductible health plans, the requirements apply after the enrollee meets the minimum deductible under IRS Section 223, except for preventive care items where requirements apply immediately

Health carriers may still utilize step therapy protocols in accordance with existing Missouri law (section 376.2034)

Provisions do not apply to plans covered under the federal Labor Management Relations Act (ERISA plans) and take effect for plans entered into, amended, extended, or renewed on or after August 28, 2026