SECOND REGULAR SESSION
SENATE BILL NO. 782
89TH GENERAL ASSEMBLY
INTRODUCED BY SENATORS HOWARD AND BENTLEY.
Read 1st time January 21, 1998, and 1,000 copies ordered printed.
TERRY L. SPIELER, Secretary.
S2429.01I
AN ACT
To repeal section 354.535, RSMo Supp. 1997, relating to health services corporations, and to enact in lieu thereof one new section relating to the same subject.
Section A. Section 354.535, RSMo Supp. 1997, is repealed and one new section enacted in lieu thereof, to be known as section 354.535, to read as follows:
354.535. 1. If a pharmacy, operated by or contracted with by a health maintenance organization, is closed or is unable to provide health care services to an enrollee in an emergency, a pharmacist may take an assignment of such enrollee's right to reimbursement, if the policy or contract provides for such reimbursement, for those goods or services provided to an enrollee of a health maintenance organization. No health maintenance organization shall refuse to pay the pharmacist any payment due the enrollee under the terms of the policy or contract.
2. No health maintenance organization, conducting business in the state of Missouri, shall contract with a pharmacy, pharmacy distributor or wholesale drug distributor, nonresident or otherwise, unless such pharmacy or distributor has been granted a permit or license from the Missouri board of pharmacy to operate in this state.
3. Every health maintenance organization shall apply the same coinsurance, copayment and deductible factors to all drug prescriptions filled by a pharmacy provider who participates in the health maintenance organization's network if the provider meets the contract's explicit product cost determination. If any such contract is rejected by any pharmacy provider, the health maintenance organization may offer other contracts necessary to comply with any network adequacy provisions of this act. However, nothing in this section shall be construed to prohibit the health maintenance organization from applying different coinsurance, copayment and deductible factors between generic and brand name drugs.
4. Health maintenance organizations shall not set a limit on the quantity of drugs which an enrollee may obtain at any one time with a prescription, unless such limit is applied uniformly to all pharmacy providers in the health maintenance organization's network.
5. Health maintenance organizations shall not insist or mandate any provider to change an enrollee's maintenance drug unless the provider and enrollee agree to such change. For the purposes of this provision, a maintenance drug shall mean a drug prescribed by a practitioner who is licensed to prescribe drugs, used to treat a medical condition for a period greater than thirty days. Violations of this provision shall be subject to the penalties provided in section 354.444. Notwithstanding other provisions of law to the contrary, health maintenance organizations that change an enrollee's maintenance drug without the consent of the provider and enrollee shall be liable for any damages resulting from such change.
[6. Notwithstanding any provision to the contrary under subsection 5 of this section, maintenance drugs as described in this section shall not include drugs which are classified as narrow therapeutic index drugs for which the United States Food and Drug Administration has approved a generic substitute.]