Missouri Lawmakers File PBM Reform Bills in 2026 Session

JEFFERSON CITY — Bills have been filed for the 2026 legislative session that aim to bring transparency, fair pricing and basic accountability to pharmacy benefits in Missouri.

The Missouri Pharmacy Business Council supports the bills, sponsored by Sen. Jill Carter, District 32 (SB 984), and Rep. John Hewkin, District 120 (HB 1850). The proposed legislation will ensure patients, employers, and community pharmacies are no longer disadvantaged by the predatory practices of monopolistic Pharmacy Benefit Managers (PBMs).

“These bills deliver long-overdue transparency and basic accountability in the prescription drug system so families, pharmacists, and employers stop paying more than they should while patients get the care they need,” Sen. Carter said.

Rep. Hewkin said, “When PBMs control pricing and steer patients to pharmacies that the PBM owns, the fallout hits everyone—patients lose access, employers face higher costs and entire communities are put at risk. These reforms give Missouri the tools to protect people, businesses and the pharmacies they depend on.”

Dozens of states have passed similar PBM reform legislation in the past year. These Missouri bills address critical issues:

Transparency & Fair Pricing

Transparency: Requires PBMs give employers and the Department of Insurance full pharmacy claims data and assigns a fiduciary duty to PBMs, so they are required to act in the best interest of the plans and patients they serve. Without these safeguards, employers and their beneficiaries are left vulnerable, as seen in recent lawsuits against Wells Fargo, Johnson & Johnson and JPMorgan Chase. While Missouri-based O’Reilly Auto Parts has sued their PBMs and health plans, alleging inflated drug costs and failures in oversight.

Fair Pricing: Prohibits PBMs from charging patients a copay higher than the actual price of a medication and ensures pharmacies are reimbursed the cost of a drug plus the same dispensing fee allowed by Medicaid.

Ending Abusive Business Practices

Fair Appeals: Creates a clear and timely process of appeal so pharmacies can challenge inaccurate or unfair reimbursements from PBMs. Today, appeals are often delayed or denied without explanation, leaving pharmacies with no meaningful recourse if a PBM opts to not pay them for filled prescriptions.

Audit Standards: Establishes uniform, reasonable rules to ensure accuracy in audits between PBMs and pharmacies. Currently, PBMs weaponize the process and, while periodic audits are necessary, under PBM control they are often punitive, arbitrary, and—according to recent lawsuits filed by independent pharmacies—used as retaliation when pharmacies raise concerns about underpayments or patient steering.

Protecting Pharmacy Access

Critical Access: Establishes a Critical Access Pharmacy Fund to help keep essential pharmacies open in rural and urban communities where one closure can leave residents without reliable access to medication or basic health services provided by local pharmacists. This prevents pharmacy deserts and Missouri patients from being cut off from care when PBM practices push local pharmacies out of the market.

Why It Matters

Local pharmacies are often the first—and sometimes the only—point of care for Missouri families.

These trusted providers deliver essential services: vaccinations, immediate access to over-the-counter treatments, medication counseling and chronic disease management.

“The long-term impact of Missouri pharmacies suffering under the greedy tactics of distant PBM

conglomerates is significant. A pharmacy is the anchor of local healthcare in many communities, and Missourians cannot afford to lose access to the vital medicines and care they provide,” said Abe Funk, a Missouri pharmacist and member of MOPBC.

Missouri patients and employers are encouraged to contact their elected officials and urge them to advance these bills.