MO SB1448

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 that have no generic substitute available

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

High-deductible health plans compatible with health savings accounts must comply with these requirements after the enrollee meets the minimum IRS deductible, with preventive care items exempt from this timing restriction

Health carriers may still utilize 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, and excludes plans covered under the federal Labor Management Relations Act