MO SB984

Increases required notice for pharmacy audits from one week to fourteen days and limits audits to 40 unique prescriptions with a maximum of 200 separately adjudicated claims, while prohibiting more than two audits per calendar year unless fraud is suspected

Requires pharmacy benefits managers to update maximum allowable cost pricing at least every seven days and prohibits placing drugs on MAC lists unless at least two therapeutically equivalent generics or one generic from at least one manufacturer is available from wholesalers

Establishes "critical access care pharmacies" as Missouri pharmacies with fewer than 500 employees located in counties with under 50,000 residents or in federally designated health professional shortage areas, and prohibits PBMs from reimbursing these pharmacies below actual drug acquisition cost

Requires PBMs to remit 100% of rebates, fees, and other remuneration from drug manufacturers to group health plans or health insurers on a quarterly basis beginning January 1, 2027, aligning with federal requirements in H.R. 7148

Mandates PBMs disclose conflicts of interest and affiliated pharmacy relationships to plan sponsors and the Department of Commerce and Insurance, including comparative pricing data between affiliated and non-affiliated pharmacies