Creates provisions relating to insurance coverage of drugs

2026 Regular Session Introduced by LaDonna Appelbaum

Prohibits insurers from forcing a change to a different drug for coverage after Jan 1, 2027; only a provider-approved change, in the patient’s health interest, is allowed.

Referred: Emerging Issues(H)

#drugsandcontrolledsubstances #insurance-health

Summary of HB 2726 (2026) – Missouri

Purpose and intent

Prohibits health carriers/health benefit plans from requiring enrollees to switch from a prescribed drug to a different drug deemed more appropriate by the insurer in order to obtain coverage.

The requirement applies to plans delivered, issued for delivery, continued, or renewed in Missouri on or after January 1, 2027.

Written approval from the enrollee’s health care provider is required for any change in drugs, and the change must be in the interest of the enrollee’s health.

Key provisions

Section added: 376.2048 (new section in Chapter 376, RSMo)

Definitions: The terms “enrollee,” “health care provider,” “health carrier,” and “health benefit plan” have the same meanings as in section 376.1350.
Prohibition on forced drug changes for coverage:
- After January 1, 2027, a health carrier or health benefit plan cannot require an enrollee to switch to a different drug (purportedly more appropriate by the insurer) in order to receive coverage for a drug that was prescribed by the enrollee’s health care provider.
- The change can only occur with written approval from the enrollee’s health care provider.
- The change must be in the interest of the enrollee’s health.
Interchangeable biological products: The bill does not prevent substitution of interchangeable biological products as described in section 338.085 (i.e., biosimilars).
Step therapy exemption: The provision does not apply to prescription drug coverage that is restricted via a step therapy protocol as described in section 376.2034 (i.e., existing step therapy requirements may still apply in certain circumstances).

Who is affected

Health carriers and health benefit plans operating in Missouri for policies delivered after January 1, 2027.

Enrollees who have prescriptions for drugs covered by their health plan.

Health care providers who write prescriptions (since their written approval is required for any drug change under this bill).

Timelines and procedural notes

Effective date for most provisions: January 1, 2027.

Referred to Emerging Issues (H) on May 15, 2026, with prior readings in January 2026.

The bill mirrors concepts from prior similar bills (HB 877, 2025; HB 1682, 2024), suggesting a continuity of reform effort on drug coverage and formulary management.

Practical impact

Enrollees retain coverage for their originally prescribed drug unless their health care provider approves a switch in the patient’s interest.

Insurers cannot unilaterally mandate switching to another drug for coverage, potentially reducing forced changes and facilitating adherence to clinically appropriate therapies.

Biosimilar substitutions are still permissible where applicable, while standard step therapy protocols may continue to govern access in certain cases.

Providers play a crucial role, since their written approval is required for any drug changes to secure coverage.

Overview

HB 2726 aims to strengthen patient autonomy in drug coverage by restricting insurer-mandated drug substitutions and placing emphasis on physician-approved changes in the interest of patient health, while preserving existing biosimilar substitution rules and step therapy exceptions.