Get AI Briefings, Transcripts & Alerts on Local & National Government Meetings — Forever.
Senate debates PBM reform bill to boost transparency and protect small pharmacies; key amendments fail and pass
Loading...
Summary
Senators debated a negotiated pharmacy benefit manager (PBM) reform package (Senate substitutes for bills 9-84 and 9-68). Sponsors said it increases transparency and limits arbitrary audits that have been harming independent pharmacies. Several floor amendments were voted on: an amendment to extend a negotiated rate floor to all pharmacies failed, while a carve-out clarifying state enforcement for self-funded plans was adopted; other amendments addressing maternal health and dispensing protections were also adopted.
The Missouri Senate spent substantial floor time on a multi-part PBM reform package built from Senate substitutes for Senate bills 9 84 and 9 68, with the sponsor, the senator from Newton, calling the measure a "landmark piece of legislation" aimed at bringing more transparency, stronger audit protections and better oversight of pharmacy benefit managers (PBMs).
The sponsor told colleagues the substitute includes auditing guardrails — a 14-day audit notice requirement, limits on retroactive audits and restrictions intended to prevent arbitrary clawbacks — and a transparency section that mirrors federal requirements scheduled to take effect in 2028. "So basically, audits right now can happen arbitrarily, and this puts guardrails on those audits," the senator from Newton said on the floor, describing negotiated language intended to protect smaller independent pharmacies.
Floor amendments generated the most debate. Senate Amendment 1 (offered by the senator from Celine) would have expanded a negotiated rate floor to apply to all pharmacies rather than only the smaller and critical-access pharmacies the deal targets. Opponents said widening the floor could shift substantial costs and produce winners and losers; proponents argued it ensures fairness across the state. The amendment failed on a recorded voice vote.
Senate Amendment 2 (offered by the senator from Jefferson) clarified that state agencies would not be required to enforce certain sections of the substitute against self-funded employer plans — an effort described by the sponsor as reducing litigation risk — and that amendment was adopted.
Other adopted changes included an amendment to require coverage of home blood-pressure monitoring devices for pregnant and postpartum people and to ensure an annual supply of contraception under applicable plans. Supporters said those health-related changes expand practical access to care; the sponsor argued the package as a whole had been negotiated with labor unions, pharmacies and insurers and represented progress after years of meetings.
Several senators remained concerned about scope and consumer impact. Lawmakers pressed the sponsor about whether the language would unintentionally favor large retail chains or increase costs for some consumers; the sponsor and backers said the negotiated compromise prioritizes small independents that they said lack negotiating leverage with vertically integrated PBMs.
After extensive floor debate and votes on multiple amendments, the sponsor laid the substitute over to the informal calendar for further consideration later in the session.