Missouri 2026 Regular Session Status: In Committee

SB 984 — Modifies provisions relating to pharmacy benefit managers

Last action — Informal Calendar S Bills for Perfection

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill is in committee in the Senate. Introduced December 01, 2025. It must pass committee before a floor vote.

Next likely step: a committee vote, then a floor vote in the Senate.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

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A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Stalled 14% · moderate confidence

  • In Committee

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

In plain language

The bill modifies regulations for pharmacy benefit managers and pharmacy audits.

This bill changes audit protocols for pharmacies, specifies cost regulations for drugs, and establishes a critical access care pharmacy program. It mandates compliance with federal law by September 1, 2028.

What this means for you
  • Workers: This affects pharmacy workers who may experience changes in audit practices and operational protocols.
  • Healthcare: Healthcare providers may see changes in how drugs are priced and billed through PBMs.

Summary

SS/SCS/SBs 984 & 968 - This act modifies provisions relating to pharmacy benefit managers. This act adds definitions for the terms "audit" and "entity" for the purposes of audits of licensed pharmacies. Current law requires a one week notice for any on-site audit. This act increases such notice to fourteen days and requires the notice to specify specific prescriptions to be audited. A pharmacy shall have the right to submit amended claims within thirty days of the discovery of an error. Audits shall be limited to forty unique prescriptions, with a maximum of two hundred separately adjudicated claims, that are randomly selected, and the act provides that recoupment shall only occur following the correction of a claim, as described in the act. No audit shall occur during the first five business days, rather than the first three, of any month. An entity shall not perform more than two audits of a pharmacy in a calendar year, unless fraud is suspected. (Section 338.600) This act modifies the definitions of "health carrier" and "pharmacy benefits manager" and adds definitions for "contracted pharmacy", "pharmacy benefits manager affiliate", for the purposes of regulating costs charged to covered persons for prescription drugs. Additionally, PBMs are prohibited from including a provision in a contract that requires payment for a prescription drug that exceeds the lesser of either the copayment amount or the amount the person would pay if they paid in cash. This act provides that the price shall also not exceed the contracted rate the pharmacy would be reimbursed for the drug. (Section 376.387) This act modifies several definitions and adds new definitions for the purpose of regulating contracts between pharmacy benefits managers and pharmacies. The act also adds several provisions relating to contracts between PBMs and pharmacies, including providing plan sponsors with pharmacy claims data, submitting documentation of any benefit design that encourages or requires the use of affiliated pharmacies, and authorizing the Department of Commerce and Insurance to conduct audits of PBMs. (Section 376.387) This act requires the Department of Commerce and Insurance to establish a critical access care pharmacy program to ensure the sustainability of critical access care pharmacies in the state. (Section 376.394) Finally, this act requires health benefit plans to comply with the federal H.R. 7148, the Consolidated Appropriations Act, by September 1, 2028. The Department of Commerce and Insurance have the authority to enforce this act. (Section 376.399) TAYLOR MIDDLETON

Bill Text

What changed in the latest version

9 added · 64 removed

Plain-language change summary

The amendment to Senate Bill 984 introduces a key clarification: it states that certain sections of the law will not require the Department of Commerce and Insurance, or any other state agency, to enforce regulations on self-funded health benefit plans. This change is significant because it provides self-funded plans with more flexibility, potentially reducing their regulatory burden and allowing them more freedom in managing their health benefits. By clearly defining the limits of enforcement, the amendment aims to ease concerns among organizations operating these plans about compliance requirements.

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5297S17.18S SENATE AMENDMENT NO.
5297S17.20S SENATE AMENDMENT NO.
984 & 968 , Page 1 , Section TITLE , Line 4 , by striking "managers";
984 & 968 , Page 14 , Section 376.399 , Line 5 , by inserting after all of said line the following:
and Further amend said bill, page 14, section 376.399, line 5, by inserting after all of said line the following:
"Section 1.
"376.1240.
Nothing in sections 338.600, 376.387, 376.394, and 376.399 shall be construed as requiring the department of commerce and insurance, or any other state agency, to enforce any provisions of these sections on self- funded health benefit plans.";
1.
For purposes of this section, terms shall have the same meanings as ascribed to them in section 376.1350, and the term "self-administered hormonal contraceptive" shall mean a drug that is composed of one or more hormones and that is approved by the Food and Drug Administration to prevent pregnancy, excluding emergency contraception.
Nothing in this section shall be construed to apply to medications approved by the Food and Drug Administration to terminate an existing pregnancy.
2.
(1) Any health benefit plan delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026, that provides coverage for self- administered hormonal contraceptives shall provide coverage to reimburse a health care provider or dispensing entity for the dispensing of a supply of self-administered hormonal contraceptives intended to last up to ninety days, or intended to last up to one hundred eighty days for generic self-administered hormonal contraceptives.
The provisions of this subdivision shall no longer be in effect after December 31, 2026.
5297S17.18S (2) Any health benefit plan delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2027, that provides coverage for self- administered hormonal contraceptives shall provide coverage to reimburse a health care provider or dispensing entity for the dispensing of a supply of self-administered hormonal contraceptives, including generic and brand-name contraceptives, intended to last up to one year.
3.
The coverage required under this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the health benefit plan.
376.1960.
1.
As used in this section, the following terms mean:
(1) "Health benefit plan", the same meaning given to the term in section 376.1350;
(2) "Home blood pressure monitoring device", a mobile device that can be used to measure blood pressure, and that is validated for clinical accuracy and device calibration;
(3) "Home blood pressure monitoring device services", patient education and training services on the setup and use of a home blood pressure monitoring device, separate self- measurement blood pressure readings, daily collection and transmission of data reports by the patient or caregiver to the health care provider in order to communicate blood pressure readings, review of the reports by the health care provider, and creation or modification of treatment plans based on the reports.
2.
Health benefit plans delivered, issued for delivery, continued or renewed in this state on or after January 1, 2026, and providing for maternity benefits, shall provide coverage for a home blood pressure monitoring device 5297S17.18S and home blood pressure monitoring device services for pregnant and postpartum women.";
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Action History

  1. Informal Calendar S Bills for Perfection

  2. SS for SCS S offered (Carter)--(5297S.17F)

  3. SA 1 to SS for SCS S offered & defeated (Gregory-21)--(5297S17.08S)

  4. SA 2 to SS for SCS S offered & adopted (Coleman)--(5297S17.20S)

  5. SA 3 to SS for SCS S offered & defeated (McCreery)--( 5297S17.05S)

  6. SA 4 to SS for SCS S offered & defeated (Gregory-15)--(5297S17.09S)

  7. SA 5 to SS for SCS S offered & adopted (Nurrenbern)--(5297S17.18S)

  8. Bill Placed on Informal Calendar

  9. Bill Placed on Informal Calendar

  10. Reported from S Families, Seniors and Health Committee w/SCS

  11. SCS Voted Do Pass w/SCS SBs 984 & 968 Families, Seniors and Health Committee (5297S.07C)

  12. Hearing Conducted S Families, Seniors and Health Committee

  13. Second Read and Referred S Families, Seniors and Health Committee

  14. S First Read

  15. Prefiled

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 198 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (198)

198 members have not signed on to this bill.

Show all 198 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does SB 984 do?
SS/SCS/SBs 984 & 968 - This act modifies provisions relating to pharmacy benefit managers. This act adds definitions for the terms "audit" and "entity" for the purposes of audits of licensed pharmacies. Current law requires a one week notice for any on-site audit. This act increases such notice to fourteen days and requires the notice to specify specific prescriptions to be audited. A pharmacy shall have the right to submit amended claims within thirty days of the discovery of an error. Audits shall be limited to forty unique prescriptions, with a maximum of two hundred separately adjudicated claims, that are randomly selected, and the act provides that recoupment shall only occur following the correction of a claim, as described in the act. No audit shall occur during the first five business days, rather than the first three, of any month. An entity shall not perform more than two audits of a pharmacy in a calendar year, unless fraud is suspected. (Section 338.600) This act modifies the definitions of "health carrier" and "pharmacy benefits manager" and adds definitions for "contracted pharmacy", "pharmacy benefits manager affiliate", for the purposes of regulating costs charged to covered persons for prescription drugs. Additionally, PBMs are prohibited from including a provision in a contract that requires payment for a prescription drug that exceeds the lesser of either the copayment amount or the amount the person would pay if they paid in cash. This act provides that the price shall also not exceed the contracted rate the pharmacy would be reimbursed for the drug. (Section 376.387) This act modifies several definitions and adds new definitions for the purpose of regulating contracts between pharmacy benefits managers and pharmacies. The act also adds several provisions relating to contracts between PBMs and pharmacies, including providing plan sponsors with pharmacy claims data, submitting documentation of any benefit design that encourages or requires the use of affiliated pharmacies, and authorizing the Department of Commerce and Insurance to conduct audits of PBMs. (Section 376.387) This act requires the Department of Commerce and Insurance to establish a critical access care pharmacy program to ensure the sustainability of critical access care pharmacies in the state. (Section 376.394) Finally, this act requires health benefit plans to comply with the federal H.R. 7148, the Consolidated Appropriations Act, by September 1, 2028. The Department of Commerce and Insurance have the authority to enforce this act. (Section 376.399) TAYLOR MIDDLETON
Who sponsors SB 984?
SB 984 is sponsored by Jill Carter.
What is the current status of SB 984?
This bill is in committee in the Senate. Introduced December 01, 2025. It must pass committee before a floor vote.
Where can I track SB 984?
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