MO SB970

Requires health carriers and pharmacy benefits managers to count payments made by or on behalf of enrollees toward out-of-pocket maximums and cost-sharing requirements for brand-name medications when no generic substitute is available

Prohibits insurers from adjusting out-of-pocket maximums or designing benefits that account for the availability of cost-sharing assistance programs (such as manufacturer copay coupons) for medications without generic alternatives

Includes an exception for HSA-qualified high deductible health plans to maintain health savings account eligibility under IRS Section 223, applying requirements only after the minimum deductible is satisfied

Exempts health benefit plans covered under the federal Labor Management Relations Act of 1947 (ERISA-covered plans)

Applies to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026