Pharmacists for Fair Reimbursement What your state's PBM laws actually mean for community pharmacies
State Tracker Updated June 15, 2026

Missouri: what the PBM reimbursement law requires

Missouri requires PBMs to keep MAC lists current (updated at least every 7 days), allow a 14-day MAC appeal, and disclose conflicts of interest — but it sets no reimbursement floor.

Status Partially enacted
Law RSMo 376.388 (MAC pricing & appeals) and 376.387 (PBM limitations)
Effective date 376.388 effective 2016; 376.387 as amended effective 2020
Reimbursement basis No reimbursement floor. PBMs must reimburse MAC-priced drugs at pricing updated to reflect market pricing at least every 7 days, provide a MAC appeal, and disclose conflicts of interest; patient cost-sharing is capped at the lesser of copay or cash price.
Professional dispensing fee Not specified in statute (MAC excludes any dispensing or professional fee)
Appeal route Pharmacy may appeal within 14 calendar days following reimbursement of the initial claim; PBM responds within 14 calendar days

Missouri regulates PBM pricing transparency but does not set a reimbursement floor. Under RSMo 376.388, a PBM must keep MAC pricing updated to reflect market pricing at least every seven days and provide a MAC appeal — limited to 14 calendar days following reimbursement of the initial claim, with a 14-day response window.

A companion statute (RSMo 376.387) caps patient cost-sharing at the lesser of the copay or cash price and requires PBMs to disclose conflicts of interest to the health carrier. Neither statute imposes a NADAC or acquisition-cost minimum on what a PBM pays.

Sources

Back to the tracker