Healthcare (Insurance)

SB 846 - This act enacts provisions relating to insurance coverage of pharmacy services. CLINICIAN-ADMINISTERED DRUGS (Section 376.411) This act provides that a health carrier or pharmacy benefits manager (PBM) shall not impose any penalty, impediment, differentiation, or limitation on participating providers for providing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to refusing to approve or pay, or reimbursing less than the contracted payment amount. Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on a covered person who is administered medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to: limiting coverage or benefits; requiring an additional fee, higher co-payment, or higher coinsurance amount; or interfering with a patient's ability to obtain a clinician-administered drug from the patient's provider or pharmacy of choice by any means, including but not limited to inducing, steering, or offering financial or other incentives. Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on any pharmacy that is dispensing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to requiring a pharmacy to dispense the drugs to a patient with the intention that the patient will transport the medication to a health care provider for administration. These provisions shall not apply if the clinician-administered drug is not otherwise covered by the carrier or PBM. These provisions are identical to provisions in SB 13 (2025), the introduced SB 751 (2024), HCS/HB 2267 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 1129 (2022), and HB 2305 (2022), and similar to provisions in SB 921 (2022), SB 1129 (2022), and HB 2305 (2022). REFERENCE PRODUCTS AND BIOSIMILARS (Section 376.415) A health carrier or PBM providing coverage for a reference product or a biological product that is biosimilar to the reference product shall provide coverage for the reference product and all biological products that have been deemed biosimilar to the reference product. The scope, extent, and amount of the required coverage shall be the same, including but not limited to any payment limitations or cost-sharing obligations. These provisions are identical to provisions in SB 13 (2025), the introduced SB 751 (2024), HCS/HB 2267 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 1129 (2022), and HB 2305 (2022), and similar to provisions in SB 921 (2022), SB 1129 (2022), and HB 2305 (2022). 340B DRUG PRICING PROGRAM (Section 376.416) Under this act, no health carrier or pharmacy benefits manager (PBM) shall discriminate against a covered entity or a pharmacy, as such terms are defined in the act, by: • Reimbursing a covered entity or pharmacy for a quantity of a 340B drug, as defined in the act, in an amount less than the carrier, PBM, or affiliate would pay to any other similarly situated pharmacy for such quantity of the drug on the basis that the entity or pharmacy is a covered entity or a pharmacy, or that the entity or pharmacy dispenses 340B drugs. (Section 376.416.2(1)); • Imposing any terms or conditions on covered entities or pharmacies which differ from the terms or conditions applicable to other similarly situated pharmacies or entities on the basis that the entity or pharmacy is a covered entity or dispenses 340B drugs, including but not limited to certain terms and conditions described in the act. (Section 376.416.2(2)); • Interfering with an individual's choice to receive a 340B drug from a covered entity or pharmacy. (Section 376.416.2(3)); • Discriminating in reimbursement to a covered entity or pharmacy based on the determination or indication a drug is a 340B drug. (Section 376.416.2(4)); • Requiring a covered entity or pharmacy to identify a 340B drug sooner than 45 days after the point of sale of the drug. (Section 376.416.2(5)); • Refusing to contract with a covered entity or pharmacy for reasons other than those that apply equally to entities or pharmacies that are not covered entities or similarly situated pharmacies, or on the basis that the entity or pharmacy is a covered entity as described under federal law, or on the basis that the entity or pharmacy is described as a covered entity under provisions of federal law. (Section 376.416.2(6)); • Denying the covered entity the ability to purchase drugs at 340B program pricing by substituting a rebate discount. (Section 376.416.2(7)); • Refusing to cover drugs purchased under the 340B drug pricing program. (Section 376.416.2(8)); or • Requiring a covered entity or pharmacy to reverse, resubmit, or clarify a 340B-drug pricing claim after the initial adjudication unless these actions are in the normal course of pharmacy business and not related to the 340B drug pricing, except as required by federal law. (Section 376.416.2(9)). The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier or PBM violating certain provisions of the act, not to exceed $5,000 per violation per day. (Section 376.416.3). These provisions are identical to provisions in SB 13 (2025), and similar to provisions in SB 372 (2025), HB 784 (2025), HB 785 (2025), HB 943 (2025), the introduced SB 751 (2024), SCS/SBs 978 & 1035 (2024), SB 1213 (2024), HCS/HB 2267 (2024), HB 1977 (2024), SB 26 (2023), HCS/HB 198 (2023), SB 426 (2023), HB 197 (2023), SB 921 (2022), HCS/HB 1677 (2022), SB 1129 (2022), and HB 2305 (2022). PRIOR AUTHORIZATION OF HEALTH CARE SERVICES (Sections 376.2100, 376.2102, 376.2104, 376.2106, and 376.2108) This act enacts provisions relating to prior authorization of health care services. Beginning January 1, 2027, health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved. Also beginning January 1, 2027, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services. Health carriers or utilization review entities may elect to have certain hospitals determine which of certain conditions, laid out in the act, the hospital will comply with in order to obtain a prior authorization exemption under the act. Exemptions from prior authorization under the act shall not apply to: pharmacy services, not to exceed the amount of $100,000; imaging services, not to exceed $100,000; cosmetic procedures that are not medically necessary; or investigative or experimental treatments. Maximum dollar amounts for these exceptions shall be adjusted annually for inflation as described in the act. The act further specifies certain prior authorization requests that shall not be included in making determinations under the act, specifies identification methods for the providers, includes provisions for the auditing and retraction of determinations under the act, allows for health carriers and utilization review entities to require providers to use an online portal to submit prior authorization requests, requires adverse determinations under the act to be reviewed by a clinical peer of the provider, and requires a grace period for patients who have received prior authorization for a 90-day supply of medication. Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act. No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act. These provisions shall not apply to MO HealthNet services not provided through a managed care organization, or to providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period. These provisions are identical to provisions contained in SB 841 (2026), SB 13 (2025), HCS/SS#2/SB 79 (2025), HB 618 (2025), and similar to SB 897 (2026), HCS/HB 3010 (2026), HB 1675 (2026), SB 230 (2025), SB 751 (2024), SB 983 (2024), HB 1976 (2024), HB 2267 (2024), SB 576 (2023), and HB 1045 (2023). TAYLOR MIDDLETON

SB 1705 - This act requires health benefit plans issued or renewed on or after January 1, 2026, to provide coverage for certain preventative health care services without cost-sharing. Such services shall be consistent with the recommendations and guidelines of the U.S. Preventative Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the Health Resources and Services Administration, and related federal rules or guidance issued as of December 31, 2025. The Director of the Department of Commerce and Insurance shall, by rule, adopt regulations to require health benefit plans to provide coverage for preventative health care services without cost-sharing requirements consistent with the recommendations and guidance of such entities issued after December 31, 2025. Additionally, this act establishes the "Health Insurance Preventative Health Care Services Advisory Committee" within the Department, which shall consist of 5 members, three of whom will represent health care providers and two of whom will represent health carriers and health benefit plans. The advisory committee shall meet at least once a year to consider any updates or modifications to the preventative health care services described in this act and shall submit a report of any recommendations to the Department, the General Assembly, and the Governor by November first each year. This act is identical to HB 3452 (2026), and substantially similar to HB 3450 (2026). TAYLOR MIDDLETON

SB 1490 - Currently, insurers shall issue payments to certain health care providers within 30 days of receipt by the insurer of all documents needed to determine the claim. This act adds athletic trainers to that list of providers. Additionally, this act adds athletic trainers to the list of practitioners covered by provisions of existing law relating to health carrier credentialing procedures. This act is identical to HB 1965 (2026) and HB 469 (2023). TAYLOR MIDDLETON

This bill establishes insurance coverage provisions for orthotic, prosthetic, and assistive devices for individuals enrolled in Missouri's MO HealthNet program, which provides health care to low-income residents. The legislation outlines specific payment rules and coverage limits for various health services, including hospital care, physician services, prescription drugs, and home health care, while explicitly excluding certain providers like abortion facilities from receiving funds. Key provisions include setting payment amounts at no more than 80% of reasonable costs for outpatient services, limiting chiropractic visits to 20 per year, and restricting nursing home coverage for those with significant home equity. The bill also defines eligibility criteria and payment methodologies for different types of care, ensuring services are medically necessary and aligned with federal regulations.

Based solely on the provided context, a detailed summary of SB 1385 cannot be generated. The official abstract only states it "modifies provisions relating to workers' compensation" without specifying *what* provisions are changed or *how* they are modified. The bill is currently in early stages (prefiled, first reading), and no concrete policy changes or affected parties are described in the available information. To create an accurate summary, specific details about the bill's provisions would be required.

This bill requires Missouri's MO HealthNet program to cover childbirth education classes for eligible low-income individuals. It achieves this by updating existing state health insurance statutes to include payment for prenatal and childbirth preparation courses as a covered benefit. The changes directly impact pregnant women enrolled in the state's Medicaid program by ensuring their insurance plans pay for these educational services. The legislation modifies current payment rules to explicitly allow reimbursement for these classes without adding new funding requirements.

This bill requires health insurance plans in Missouri to cover nonopioid pain medications without discrimination when prescribed by a licensed healthcare professional for acute pain. It prohibits insurers from denying coverage for nonopioid drugs in favor of opioids, forcing patients to try opioids first, or charging higher copays for nonopioid options. The law applies to all health benefit plans issued or renewed in the state on or after January 1, 2027.

HB 3168 requires Missouri health insurance plans to cover doula services starting January 1, 2027. It mandates coverage for pregnant women enrolled in MO HealthNet (Missouri's Medicaid program), including up to 16 support sessions (6 base sessions plus 10 additional if needed) during pregnancy and the first year postpartum. The bill defines "doula services" as nonmedical birth support, including prenatal education, labor assistance, and postpartum care, and requires the Department of Health to establish registration criteria for doulas to qualify for reimbursement. It exempts supplemental policies like accident-only or Medicare supplement plans from this requirement. The bill is currently in committee after its first reading in February 2026.

SB 1687 modifies Missouri's MO HealthNet program to clarify how the state recovers payments from third parties (like insurance companies or liable entities) when they are responsible for medical costs. It establishes MO HealthNet as the "payer of last resort," requiring third parties to reimburse the state for covered services paid by MO HealthNet, with claims due within three years of service. The bill specifies that insurers must process valid subrogation claims without denying them for late submission, missing documentation, or prior authorization issues (except for Medicare plans), and limits reimbursement to amounts the insurer would have paid if billed properly. This directly affects MO HealthNet participants, healthcare providers, and third-party insurers by streamlining recovery processes and setting clear timelines.

HB 3450 requires health insurance plans sold in the state to cover specific preventive health services without cost-sharing (like copays or deductibles) starting January 1, 2026. It mandates coverage for services rated A or B by the U.S. Preventive Services Task Force, CDC-recommended vaccinations, and other preventive care outlined in federal guidelines from the Health Resources and Services Administration. This applies directly to health insurers and plans operating in the state, though it allows cost-sharing for out-of-network providers and makes exceptions for high-deductible health plans under federal rules. The law ties coverage requirements to current federal guidelines, with updates to be adopted by the state insurance director based on new federal recommendations.