Missouri legislators push for PBM oversight to protect patients, pharmacies

FOX23 News at 9 p.m

JEFFERSON CITY, Mo., (KBSI) — Missouri lawmakers have filed legislation for the 2026 session aimed at increasing transparency, fairness and accountability in pharmacy benefit management practices across the state. The Missouri Pharmacy Business Council is backing the bills, sponsored by Sen. Jill Carter of District 32 (SB 984) and Rep. John Hewkin of District 120 (HB 1850).

Supporters of the legislation say the measures would help protect patients, employers and community pharmacies from what they describe as predatory and anti-competitive practices by large Pharmacy Benefit Managers, or 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 PBM control over drug pricing and patient steering has broad consequences. “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 measures in the past year. The Missouri bills address three key areas:

Transparency: PBMs would be required to provide employers and the Missouri Department of Insurance with full pharmacy claims data and would operate under a fiduciary duty to act in the best interest of plans and patients. Advocates note that lack of oversight has resulted in lawsuits nationwide, including actions involving Wells Fargo, Johnson & Johnson and JPMorgan Chase, as well as Missouri-based O’Reilly Auto Parts.

Fair Pricing: PBMs would be prohibited from charging copays higher than the actual cost of a drug and would be required to reimburse pharmacies at the drug’s acquisition cost plus the Medicaid dispensing fee.

Fair Appeals: The legislation would establish a standardized, timely appeals process allowing pharmacies to challenge inaccurate or unfair PBM reimbursements.

Audit Standards: The bills would create uniform rules for PBM audits, which independent pharmacies say are often used punitively or as retaliation when concerns are raised about underpayments or patient steering.

Critical Access: The bills would establish a Critical Access Pharmacy Fund to support pharmacies in communities—both rural and urban—where closures could leave residents without reasonable access to basic medications and pharmacy services. Supporters say the fund would help prevent “pharmacy deserts” created by PBM-driven market pressures.

Local pharmacists say the stakes are high.

“The long-term impact of Missouri pharmacies suffering under the greedy tactics of distant PBM conglomerates is significant,” said Abe Funk, a Missouri pharmacist and member of the Missouri Pharmacy Business Council. “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.”

The Missouri Pharmacy Business Council is encouraging patients and employers to contact lawmakers in support of the bills. More information is available at Our Mission | MOPBC | Stop PBM Abuse | Fair Medication Prices | Missouri Anti-PBM Bill.