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SB 878MISSOURISession 2026State BillSigned into law
Enacted

Missouri modifies pharmacy rules, raises meth precursor limits, and prohibits health plan discrimination against 340B drug entities

Original title: Modifies provisions relating to pharmaceutical drugs and devices

Last action · August 20, 2026: Signed by GovernorSponsor: Travis Fitzwater

Bill progressHistory & official text ↓
Introduced
Committee
Floor Vote
Passed
Law

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What This Bill Does

Senate Bill 878 updates state laws regarding pharmaceuticals and medical devices by raising the 12-month purchase limit for certain over-the-counter s from 43.2 grams to 61.2 grams, permitting pharmacists to prescribe certain medical devices, and allowing the dispensing of ivermectin and hydroxychloroquine without a prescription under specific guidelines. Additionally, the measure prohibits health carriers and s from discriminating against 340B covered entities, bans health plans from favoring opioids over nonopioid prescription drugs starting January 1, 2027, and mandates maternity health plan coverage for home blood pressure monitoring devices.

Why it matters

Residents seeking specific over-the-counter medications face higher purchase caps, pregnant and postpartum women gain mandatory insurance coverage for home blood pressure monitoring devices starting in 2027, and health plans are barred from requiring patients to try opioids before covering nonopioid alternatives.

Background
  • SB 878 modifies multiple sections of Missouri law related to pharmaceutical distribution, tracking systems, pharmacy practice authority, and health insurance mandates. context

Who It Affects

Groups the bill's text affects, as described in the record. Being affected is not a position for or against it.

Directly affected

Manufacturers of meth precursor drugs

Manufacturers must pay a monthly fee to the real-time electronic pseudoephedrine tracking system administrator starting October 1, 2026, and face criminal offenses for non-payment.

Directly affected

Pharmacists and pharmacy technicians

Pharmacists gain authority to prescribe medical devices, dispense specific drugs without a prescription under protocols, and store certain medications securely behind the counter.

Directly affected

Health carriers and pharmacy benefits managers

These entities are prohibited from discriminating against 340B covered entities in reimbursement or terms and face civil penalties of up to $5,000 per violation per day.

Directly affected

Pregnant and postpartum women

Health plans providing maternity benefits must cover home blood pressure monitoring devices and services when medically appropriate under ACOG guidelines starting in 2027.

Key Facts

You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.

Frequently Asked Questions

What is the new purchase limit for over-the-counter meth precursor drugs?
The 12-month purchase limit is increased from a total of 43.2 grams to 61.2 grams.
Can I obtain ivermectin or hydroxychloroquine without a prescription under this law?
Yes, a pharmacist may dispense ivermectin and hydroxychloroquine without a prescription order upon the approval of a warning label and in accordance with written, standardized procedures or protocols issued by the Board of Pharmacy.
When do the health plan requirements regarding nonopioid drugs and home blood pressure monitors take effect?
These provisions apply to health benefit plans delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2027.
What penalties exist for health carriers or pharmacy benefits managers that discriminate against 340B entities?
The Director of the Department of Commerce and Insurance shall impose a civil penalty not to exceed $5,000 per violation per day on any health carrier, , or agent/affiliate that violates the 340B anti-discrimination provision.

What else do you want to know?

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Where This Stands

Current status: Signed into law.

Procedural history

37 actions
  1. Aug 20, 2026Office of the GovernorEnrolled
    Signed by Governor
  2. May 28, 2026Senate
    Reported Duly Enrolled Rules, Joint Rules, Resolutions & Ethics Committee
  3. May 28, 2026Senate
    Signed by Senate President Pro Tem
  4. May 28, 2026House
    Signed by House Speaker
  5. May 28, 2026Office of the Governor
    Delivered to Governor
  6. May 12, 2026Senate
    S concurs in HCS, as amended
Show 31 earlier actions
  1. May 12, 2026SenateFloor
    S Third Read and Passed
  2. May 12, 2026SenateFloor
    Truly Agreed To and Finally Passed
  3. May 11, 2026HouseCommittee
    Voted Do Pass H Fiscal Review
  4. May 11, 2026HouseCommittee
    Reported Do Pass H Fiscal Review
  5. May 11, 2026House
    Bill Placed on H Informal Calendar
  6. May 11, 2026House
    HA 1 to HCS H offered & adopted (Stinnett)--(5598H07.07H)
  7. May 11, 2026House
    HCS, as amended, H adopted --(5598H.07C)
  8. May 11, 2026HouseFloor
    H Third Read and Passed
  9. May 7, 2026HouseCommittee
    Referred H Fiscal Review Committee
  10. May 5, 2026HouseCommittee
    HCS Reported Do Pass H Rules - Legislative
  11. May 4, 2026HouseCommittee
    HCS Voted Do Pass H Rules - Legislative
  12. Apr 30, 2026HouseCommittee
    HCS Voted Do Pass H Health and Mental Health
  13. Apr 30, 2026HouseCommittee
    HCS Reported Do Pass H Health and Mental Health
  14. Apr 30, 2026HouseCommittee
    HCS Referred H Rules - Legislative
  15. Apr 23, 2026House
    Hearing Conducted H Health and Mental Health
  16. Apr 16, 2026HouseCommittee
    Referred H Health and Mental Health
  17. Mar 24, 2026HouseFloor
    H Second Read
  18. Mar 23, 2026SenateFloor
    S Third Read and Passed
  19. Mar 23, 2026HouseIntroduced
    H First Read
  20. Mar 12, 2026Senate
    Reported Truly Perfected S Rules, Joint Rules, Resolutions and Ethics Committee
  21. Mar 11, 2026Senate
    SS for SCS S offered (Fitzwater)--(5598S.05F)
  22. Mar 11, 2026Senate
    SA 1 to SS for SCS S offered & adopted (McCreery)--(5598S05.06S)
  23. Mar 11, 2026Senate
    SA 2 to SS for SCS S offered & adopted (Nicola)--(5598S05.10S)
  24. Mar 11, 2026SenateFloor
    SS for SCS, as amended, S adopted
  25. Mar 11, 2026Senate
    Perfected
  26. Feb 26, 2026Senate
    SCS Reported from S Families, Seniors and Health Committee
  27. Feb 4, 2026SenateCommittee
    SCS Voted Do Pass S Families, Seniors and Health Committee (5598S.03C)
  28. Jan 14, 2026Senate
    Hearing Conducted S Families, Seniors and Health Committee
  29. Jan 8, 2026SenateFloor
    Second Read and Referred S Families, Seniors and Health Committee
  30. Jan 7, 2026SenateIntroduced
    S First Read
  31. Dec 1, 2025Senate
    Prefiled

Version history & redline

8 versions on file
Comparing 5598S.05P - Perfected → 3/11/2026 - SA 1 to SS for SCS S offered & adopted (McCreery)--(5598S05.06S) 3/11/2026 - Adopted
Board of PharmacyDepartment of Health and Senior ServicesState Board of Registration for the Healing Arts
removed addedOfficial text
removed: EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted and is intended to be omitted in the law. SECOND REGULAR SESSION [PERFECTED] SENATE SUBSTITUTE FOR SENATE COMMITTEE SUBSTITUTE FOR added: 5598S05.06S 1 SENATE removed: BILL added: AMENDMENT NO. removed: 878 103RD GENERAL ASSEMBLY INTRODUCED BY SENATOR FITZWATER. 5598S.05P KRISTINA MARTIN, Secretary AN ACT To repeal sections 338.010 and 338.012, RSMo, and to enact in lieu thereof five new sections relating to the duties of a pharmacist. Be it enacted added: ___ Offered by removed: the General Assembly of the State of Missouri, as follows: Section A. Sections 338.010 and 338.012, RSMo, are repealed and five new sections enacted in lieu thereof, to be known as sections 338.010, 338.012, 338.206, 338.208, and 338.010. 1. The "practice of pharmacy" includes: (1) The interpretation, implementation, and evaluation of medical prescription orders, including any legend drugs under 21 U.S.C. added: Of Amend SS/SCS/Senate Bill No. 878 , Page 8 , Section removed: 353, and the receipt, transmission, or handling of such orders or facilitating the dispensing of such orders; (2) The designing, initiating, implementing, and monitoring of a medication therapeutic plan in accordance with the provisions of this section; (3) The compounding, dispensing, labeling, and administration of drugs and devices pursuant to medical prescription orders; (4) The ordering and administration of vaccines approved or authorized by the U.S. Food and Drug Administration, as of January 1, 2026, or thereafter, excluding vaccines for cholera, monkeypox, Japanese encephalitis, typhoid, rabies, yellow fever, tick-borne encephalitis, anthrax, tuberculosis, dengue, Hib, polio, rotavirus, smallpox, [and any vaccine approved after January 1, 2023] or any vaccine that is not jointly included by joint rules promulgated by the board of pharmacy and the state board of registration for the healing arts, to persons at least seven years of age or the age recommended by the Centers for Disease Control and Prevention, whichever is older, pursuant to joint promulgation of rules established by the board of pharmacy and the state board of registration for the healing arts unless rules are established under a state of emergency as described in section 44.100; (5) The participation in drug selection according to state law and participation in drug utilization reviews; (6) The proper and safe storage of drugs and devices and the maintenance of proper records thereof; (7) Consultation with patients and other health care practitioners, and veterinarians and their clients about legend drugs, about the safe and effective use of drugs and devices; (8) The prescribing and dispensing of any nicotine replacement therapy product under section 338.665; (9) The dispensing of HIV postexposure prophylaxis pursuant to section 338.730; and (10) The offering or performing of those acts, services, operations, or transactions necessary in the conduct, operation, management and control of a pharmacy. 2. No person shall engage in the practice of pharmacy unless he or she is licensed under the provisions of this chapter. 3. This chapter shall not be construed to prohibit the use of auxiliary personnel under the direct supervision of a pharmacist from assisting the pharmacist in any of his or her duties. This assistance in no way is intended to relieve the pharmacist from his or her responsibilities for compliance with this chapter and he or she will be responsible for the actions of the auxiliary personnel acting in his or her assistance. 4. This chapter shall not be construed to prohibit or interfere with any legally registered practitioner of medicine, dentistry, or podiatry, or veterinary medicine only for use in animals, or the practice of optometry in accordance with and as provided in sections 195.070 and 336.220 in the compounding, administering, prescribing, or dispensing of his or her own prescriptions. 5. A pharmacist with a certificate of medication therapeutic plan authority may provide medication therapy services pursuant to a written protocol from a physician licensed under chapter 334 to patients who have established a physician-patient relationship, as described in subdivision (1) of subsection 1 of section 191.1146, with the protocol physician. The written protocol authorized by this section shall come only from the physician and shall not come from a nurse engaged in a collaborative practice arrangement under section 334.104, or from a physician assistant engaged in a collaborative practice arrangement under section 334.735. 6. Nothing in this section shall be construed as to prevent any person, firm or corporation from owning a pharmacy regulated by sections 338.210 to 338.315, provided that a licensed pharmacist is in charge of such pharmacy. 7. Nothing in this section shall be construed to apply to or interfere with the sale of nonprescription drugs and the ordinary household remedies and such drugs or medicines as are normally sold by those engaged in the sale of general merchandise. 8. No health carrier as defined in chapter 376 shall require any physician with which they contract to enter into a written protocol with a pharmacist for medication therapeutic services. 9. This section shall not be construed to allow a pharmacist to diagnose or independently prescribe pharmaceuticals. 10. The state board of registration for the healing arts, under section 334.125, and the state board of pharmacy, under section 338.140, shall jointly promulgate rules regulating the use of protocols for medication therapy services. Such rules shall require protocols to include provisions allowing for timely communication between the pharmacist and the protocol physician or similar body authorized by this section, and any other patient protection provisions deemed appropriate by both boards. In order to take effect, such rules shall be approved by a majority vote of a quorum of each board. Neither board shall separately promulgate rules regulating the use of protocols for medication therapy services. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void. 11. The state board of pharmacy may grant a certificate of medication therapeutic plan authority to a licensed pharmacist who submits proof of successful completion of a board-approved course of academic clinical study beyond a bachelor of science in pharmacy, including but not limited to clinical assessment skills, from a nationally accredited college or university, or a certification of equivalence issued by a nationally recognized professional organization and approved by the board of pharmacy. 12. Any pharmacist who has received a certificate of medication therapeutic plan authority may engage in the designing, initiating, implementing, and monitoring of a medication therapeutic plan as defined by a written protocol from a physician that may be specific to each patient for care by a pharmacist. 13. Nothing in this section shall be construed to allow a pharmacist to make a therapeutic substitution of a pharmaceutical prescribed by a physician unless authorized by the written protocol or the physician's prescription order. 14. "Veterinarian", "doctor of veterinary medicine", "practitioner of veterinary medicine", "DVM", "VMD", "BVSe", "BVMS", "BSe (Vet Science)", "VMB", "MRCVS", or an equivalent title means a person who has received a doctor's degree in veterinary medicine from an accredited school of veterinary medicine or holds an Educational Commission for Foreign Veterinary Graduates (EDFVG) certificate issued by the American Veterinary Medical Association (AVMA). 15. In addition to other requirements established by the joint promulgation of rules by the board of pharmacy and the state board of registration for the healing arts: (1) A pharmacist shall administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease Control and Prevention (CDC); (2) A pharmacist who is administering a vaccine shall request a patient to remain in the pharmacy a safe amount of time after administering the vaccine to observe any adverse reactions. Such pharmacist shall have adopted emergency treatment protocols. 16. In addition to other requirements by the board, a pharmacist shall receive additional training as required by the board and evidenced by receiving a certificate from the board upon completion, and shall display the certification in his or her pharmacy where vaccines are delivered. 17. A pharmacist shall inform the patient that the administration of a vaccine will be entered into the ShowMeVax system, as administered by the department of health and senior services. The patient shall attest to the inclusion of such information in the system by signing a form provided by the pharmacist. If the patient indicates that he or she does not want such information entered into the ShowMeVax system, the pharmacist shall provide a written report within fourteen days of administration of a vaccine to the patient's health care provider, if provided by the patient, containing: (1) The identity of the patient; (2) The identity of the vaccine or vaccines administered; (3) The route of administration; (4) The anatomic site of the administration; (5) The dose administered; and (6) The date of administration. 18. A pharmacist licensed under this chapter may order and administer vaccines approved or authorized by the U.S. Food and Drug Administration to address a public health need, as lawfully authorized by the state or federal government, or a department or agency thereof, during a state or federally declared public health emergency. 338.012. 1. A pharmacist with a certificate of medication therapeutic plan authority may provide influenza, group A streptococcus, and COVID-19 medication therapy services pursuant to [a statewide standing order issued by the director or chief medical officer of the department of health and senior services if that person is a licensed physician, or a licensed physician designated by the department of health and senior services] rules established added: 338.206 , Line 36 , by removed: the board of pharmacy and the state board of registration for the healing arts, as described in this section. 2. This section shall not be construed to allow a pharmacist to diagnose or independently prescribe pharmaceuticals. 3. The state board of registration for the healing arts, pursuant to section 334.125, and the state board of pharmacy, pursuant to section 338.140, shall jointly promulgate rules to implement the provisions of this section. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted added: inserting after removed: August 28, 2023, shall be invalid and void. 338.206. 1. As used in this section, the term "medical device" shall mean equipment that is furnished by a supplier or a home health agency and meets the following conditions: (1) Is a device classified by the United States Food and Drug Administration as a Class I or Class II under 21 U.S.C. Section 360 and its implementing regulations under 21 CFR Parts 860 to 892; (2) Is primarily and customarily used to serve a medical purpose; (3) Generally is not useful to an individual in the absence of an illness or injury; and (4) Is appropriate for use in the home. 2. Notwithstanding any provision of this chapter to the contrary, pharmacists may prescribe any medical devices authorized by rule promulgated jointly by the state board of registration for the healing arts and the board of pharmacy in accordance with subsection 3 of this section. 3. The state board of registration for the healing arts, pursuant to section 334.125, and the board of pharmacy, pursuant to section 338.140, shall jointly promulgate rules to implement the provisions of this section. Such rules shall be written and effective within six months of the effective date of this act. 4. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of removed: the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2026, shall be invalid and void. 338.208. Notwithstanding any other provision of law to the contrary, a pharmacist may dispense ivermectin and hydroxychloroquine to a person, without requiring a prescription order from a licensed health care practitioner, upon the approval of a warning label for the use and indication in accordance with any written, standardized procedures or protocols for the pharmacist issued by the board of pharmacy, including, if required, providing the person with instructions on added: said line the removed: proper use of ivermectin and hydroxychloroquine. 338.312. added: following:2 "338.312. 1. As used in this section, unless removed: the added: the3 context requires otherwise, the following terms removed: mean: added: mean:4 (1) "Declared state disaster or emergency", a removed: disaster added: disaster5 or emergency event for which a governor's state of removed: emergency added: emergency6 proclamation has been issued or that the President of removed: the added: the7 United States has declared to be a major disaster removed: or emergency; added: or8 emergency;9 (2) "Disaster period", the period of time that removed: begins added: begins10 ten days before a governor's proclamation of a state removed: of added: of1 emergency or the declaration by the President of the removed: United added: United1 States of a major disaster or emergency, whichever removed: occurs added: occurs1 first, and extending for a period of sixty calendar removed: days added: days1 following the end of the period specified in removed: the added: the1 proclamation or declaration or sixty calendar days from removed: the added: the1 proclamation or declaration if no end is provided. removed: The added: The1 governor may extend the disaster period as removed: warranted; added: warranted;1 (3) "Nonprofit pharmacy", any pharmacy licensed removed: in this state that operates as a charitable organization under added: in1 Section 501(c)(3) of the Internal Revenue Code of 1986, removed: as amended. added: as2 amended.2 2. Notwithstanding any provision of law to removed: the added: the2 contrary, the board of pharmacy shall have the authority removed: to added: to2 waive compliance with any Missouri rules and regulations removed: for added: for2 pharmacies licensed in this state when such removed: nonprofit added: nonprofit2 pharmacy is dispensing, shipping, or delivering removed: prescription added: prescription2 drugs into another state or United States territory that removed: is added: is2 experiencing a declared state disaster or removed: emergency, provided that: added: emergency,2 (1) The nonprofit pharmacy is a licensed pharmacy removed: in added: in3 good standing under this chapter and is authorized to removed: ship added: ship3 prescription drugs into the state or territory in removed: question; added: question;3 (2) The nonprofit pharmacy is responding to an removed: active added: active3 declared state disaster or removed: emergency; added: emergency;3 (3) The nonprofit pharmacy complies with all removed: emergency added: emergency3 rules and regulations for pharmacies and removed: nonprofit added: nonprofit3 pharmacies established by the state or territory for removed: the added: the3 duration of the disaster removed: period; (4) The nonprofit pharmacy complies with all added: period;3 applicable federal laws and regulations; removed: and added: and4 (5) The waiver applies only to prescription removed: drugs added: drugs4 dispensed, shipped, or delivered to residents or health removed: care added: care4 facilities located within the geographic area specified removed: in added: in4 the declared state disaster or removed: emergency. added: emergency.4 3. The board of pharmacy may promulgate rules removed: to added: to4 implement the provisions of this section. Any rule removed: or added: or4 portion of a rule, as that term is defined in removed: section added: section4 536.010, that is created under the authority delegated removed: in this section shall become effective only if it complies with added: in4 and is subject to all of the provisions of chapter 536 removed: and, added: and,5 if applicable, section 536.028. This section and removed: chapter added: chapter5 536 are nonseverable and if any of the powers vested removed: with added: with5 the general assembly pursuant to chapter 536 to review, removed: to added: to5 delay the effective date, or to disapprove and annul a removed: rule added: rule5 are subsequently held unconstitutional, then the grant removed: of added: of5 rulemaking authority and any rule proposed or adopted removed: after added: after5 August 28, 2026, shall be invalid and removed: void.added: void."; and5 Further amend the title and enacting clause accordingly.5
Redline computed from the official version text (record lane).View this version →

Lobbying Activity

No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.

Full breakdown

Who this bill affects and the strongest case for and against it, written only from the bill’s own text.

Sponsors

Travis FitzwaterRepublicanPrimary sponsor

Discoveries

1 pattern noticed across the record

Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.

cross reference99% confidence

Extensive Legislative Alignment

The text explicitly notes that its provisions are identical or similar to dozens of other bills from the 2025 and 2026 legislative sessions, indicating a comprehensive bundling of pharmaceutical policy reforms.

SB 841SS/SCS/HCS/HB 2372

Connected Entities

Travis Fitzwater, Department of Health and Senior Services, Department of Commerce and Insurance and 4 more
PersonTravis Fitzwater“Republican sponsor of SB 878”Map →
OrganizationDepartment of Health and Senior Services“State department previously involved in medication therapeutic plan authority”Map →
OrganizationDepartment of Commerce and Insurance“State department whose Director imposes civil penalties for 340B violations”Map →
OrganizationBoard of Pharmacy“State board responsible for promulgating rules, issuing waivers, and establishin”Map →
OrganizationAmerican College of Obstetricians and Gynecologists“Organization whose guidelines determine medical appropriateness for blood pressu”Map →
OrganizationState Board of Registration for the Healing Arts“State board partnering with the Board of Pharmacy to promulgate joint rules”Map →
PersonKatie O'Brien“Mentioned at the conclusion of the source document text”Map →

Sources

Open source document

www.senate.mo.gov

Analysis Score

0–100
  • Significance75
    How much this matters to a regular citizen
  • Controversy45
    Intensity of disagreement among stakeholders
  • Entertainment10
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  • Buzz35
    Current news / social attention level

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