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Read. Follow. Verify.Missouri HB 1681 requires health plans to count third-party payments toward out-of-pocket maximums for drugs without generic substitutes
Last action · February 12, 2026: HCS Voted Do Pass (H)Sponsor: Brian Seitz
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What This Bill Would Do
Health carriers and s must include payments made by or on behalf of an enrollee toward out-of-pocket maximums and requirements for medications lacking a generic substitute, effective August 28, 2026. The legislation also prohibits health plans from varying cost-sharing requirements based on the availability of assistance programs for such medications. Plans covered under the Labor Management Relations Act are exempt from these requirements.
Enrollees utilizing manufacturer coupons or third-party financial assistance for brand-name drugs without generic equivalents will see those payments count directly toward their deductible and out-of-pocket limits, potentially accelerating the point at which insurance covers total costs.
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Health plan enrollees
Enrollees using medications without generic substitutes will have third-party payments and copay assistance counted toward their out-of-pocket maximums and deductibles.
Health carriers
Health carriers must modify how they calculate out-of-pocket maximums and cost-sharing requirements for applicable medications in plans renewed or entered into on or after August 28, 2026.
Pharmacy benefits managers
Pharmacy benefits managers are prohibited from adjusting cost-sharing or out-of-pocket maximums based on the availability of cost-sharing assistance programs for drugs lacking generic equivalents.
Key Facts
- Health carriers and pharmacy benefits managers must count any amounts paid by or for an enrollee for a medication toward out-of-pocket maximums and cost-sharing requirements when no generic substitute is available.
- Health carriers and pharmacy benefits managers are prohibited from varying an enrollee's out-of-pocket maximum or cost-sharing requirements based on the availability of a cost-sharing assistance program for medications without generic substitutes.
- For health savings account-qualified high deductible health plans, the counting requirement applies after the enrollee satisfies the minimum deductible under Section 223 of the Internal Revenue Code, except for preventive care items or services where it applies regardless.
- Health carriers and health benefit plans retain the ability to utilize step therapy in accordance with section 376.2034.
Show all 6 facts
- Health benefit plans covered under the Labor Management Relations Act of 1947 are exempt from the provisions of this section.
- The provisions apply to health benefit plans entered into, amended, extended, or renewed on or after August 28, 2026.
Frequently Asked Questions
What triggers the requirement to count third-party payments toward out-of-pocket maximums?
Are health savings account-qualified high deductible health plans subject to this rule?
Which health plans are exempt from these provisions?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
8 actions- Feb 12, 2026HouseCommitteeHCS Voted Do Pass (H)
- Feb 12, 2026HouseExecutive Session Completed (H)
- Feb 12, 2026HousePublic Hearing Completed (H)
- Feb 12, 2026HouseCommitteeHCS Reported Do Pass (H)
- Feb 5, 2026HouseCommitteeReferred: Health and Mental Health(H)
- Jan 8, 2026HouseFloorRead Second Time (H)
Show 2 earlier actions
- Jan 7, 2026HouseIntroducedRead First Time (H)
- Dec 1, 2025HouseIntroducedPrefiled (H)
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →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
Sources
house.mo.gov
Analysis Score
0–100- Significance65How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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