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MissouriSB8782026 Regular SessionSenateWALLET

Modifies provisions relating to pharmaceutical drugs and devices

Sponsored By: Travis Fitzwater (Republican)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

10 provisions identified: 8 benefits, 1 costs, 1 mixed.

Blood pressure monitor coverage for mothers

Nora's Law covers maternity plans delivered, issued, continued, or renewed in Missouri on or after January 1, 2027. Plans must cover prescribed home blood pressure monitors and related education and training during pregnancy and within 12 months postpartum. The device and services must meet medical-necessity requirements and American College of Obstetricians and Gynecologists guidelines. Repeat prescriptions are limited to a worsening condition that requires one or a subsequent pregnancy.

Coverage protections for nonopioid pain drugs

These protections apply to health plans delivered, issued, continued, or renewed on or after January 1, 2027. Plans cannot deny a prescribed nonopioid pain drug in favor of an opioid or require patients to try opioids first. They also cannot charge higher cost-sharing for the nonopioid than for the opioid. A licensed health professional must prescribe it for acute or chronic pain with multiple FDA-approved nonopioid drugs indicated.

Higher yearly limits for certain decongestants

The law raises the combined 12-month limit for covered ephedrine, phenylpropanolamine, and pseudoephedrine products from 43.2 to 61.2 grams. It also raises the related criminal offense threshold from 43 to 61.2 grams. Separate limits remain: 3.6 grams in 24 hours and 7.2 grams in 30 days. Quantities handled by a pharmacy under a valid prescription remain exempt.

Pharmacists can offer newer vaccines

Pharmacists can order and give qualifying vaccines approved or authorized by the FDA on or after January 1, 2026. Patients must be at least seven years old, or meet an older minimum age recommended by the CDC. Vaccines approved or authorized after January 1, 2026, must be included in joint pharmacy and medical board rules. The law's listed vaccine exclusions remain in place.

Pharmacists can prescribe approved medical devices

Pharmacists can prescribe medical devices authorized by joint rules of Missouri's pharmacy and medical boards. The boards must write the rules and make them effective within six months after this section takes effect. The rules determine which devices pharmacists can prescribe.

Prescription-free access to two pharmacy drugs

Pharmacists can dispense ivermectin or hydroxychloroquine without a prescription from a licensed health care practitioner. Dispensing requires an approved warning label for the use and indication, plus written pharmacy board procedures or protocols. The drugs must stay in secure storage accessible only to pharmacy personnel, not on self-service shelves. A pharmacist must dispense them or supervise a pharmacy technician who does.

Pharmacy waivers support disaster drug deliveries

Missouri's pharmacy board can waive state rules for eligible Missouri-based pharmacies sending prescription drugs to disaster areas in other states or U.S. territories. Pharmacies must be licensed, in good standing, authorized to ship there, and follow federal law and the affected jurisdiction's emergency rules. Waivers cover deliveries only to residents or health facilities within the declared area. The disaster period starts 10 days before declaration and ends 60 calendar days after its stated end. With no stated end, it ends 60 calendar days after declaration; the governor can extend the period.

Fairer insurer payments for discounted-drug providers

Insurers and pharmacy benefit managers cannot discriminate against providers participating in the federal 340B discounted-drug program. They cannot pay less or impose different terms than for similar providers, demand 340B identification, or refuse drug coverage. They also cannot require claim reversals, resubmissions, or clarifications tied to 340B pricing after the claim is first processed. Normal pharmacy business unrelated to 340B pricing and actions required by federal law remain allowed. Missouri's insurance director must impose civil penalties of up to $5,000 per violation per day.

Drug manufacturers pay new tracking fees

Beginning October 1, 2026, manufacturers of covered ephedrine, phenylpropanolamine, and pseudoephedrine products sold in Missouri must pay monthly tracking fees. The requirement also covers products sold into Missouri. The electronic tracking system administrator sets fees based only on transactions involving each manufacturer's own products. Manufacturers must provide payment documentation to the state health department on request. Knowingly failing to pay is a class A misdemeanor.

New rules for pharmacist infection care

Certified pharmacists retain authority to provide medication therapy services for influenza, group A strep, and COVID-19. But the law removes the statewide standing-order pathway and requires services to follow joint pharmacy and medical board rules. Pharmacists must hold a certificate of medication therapeutic plan authority.

Sponsors & Cosponsors

Sponsor

  • Travis Fitzwater

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 30 • No: 2

House vote • 5/11/2026

Reported Do Pass

Yes: 8 • No: 0

House vote • 5/5/2026

Reported Do Pass

Yes: 9 • No: 0

House vote • 4/30/2026

HCS Reported Do Pass

Yes: 13 • No: 2

Actions Timeline

  1. Delivered to Secretary of State (G)

    7/13/2026

  2. Approved by Governor (G)

    7/13/2026

  3. Delivered to Governor

    5/28/2026

  4. Signed by House Speaker

    5/28/2026House

  5. Truly Agreed To and Finally Passed

    5/12/2026

  6. Taken Up

    5/12/2026

  7. Reported to the Senate with... - HCS, as amended

    5/11/2026House

  8. Third Read and Passed with Amendments - With HA 1

    5/11/2026House

  9. HCS Adopted

    5/11/2026House

  10. Title of Bill - Agreed To

    5/11/2026

  11. Taken Up for Third Reading

    5/11/2026House

  12. Placed on the Informal Third Reading Calendar

    5/11/2026House

  13. Reported Do Pass - AYES: 8 NOES: 0 PRESENT: 0

    5/11/2026House

  14. Voted Do Pass

    5/11/2026House

  15. Executive Session Completed

    5/11/2026House

  16. Referred: Fiscal Review

    5/7/2026House

  17. Reported Do Pass - AYES: 9 NOES: 0 PRESENT: 0

    5/5/2026House

  18. Voted Do Pass

    5/4/2026House

  19. Executive Session Completed

    5/4/2026House

  20. Referred: Rules - Legislative

    4/30/2026House

  21. HCS Reported Do Pass - AYES: 13 NOES: 2 PRESENT: 0

    4/30/2026House

  22. HCS Voted Do Pass

    4/30/2026House

  23. Executive Session Completed

    4/30/2026House

  24. Public Hearing Completed

    4/23/2026House

  25. Referred: Health and Mental Health

    4/16/2026House

Bill Text

  • Truly Agreed

    5/12/2026

    PDF

  • Committee Substitute

    PDF

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