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HB 3499

Modifies the duties of a pharmacist

2026 Regular Session Introduced by Bennie Cook

Expands pharmacist roles to include prescribing certain medical devices and providing targeted medication therapy services under jointly created rules.

Referred: Emerging Issues(H)
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Bill Summary · HB 3499

Summary of HB 3499 (2026) — Missouri

Main purpose and intent

  • Modernize and expand the duties of pharmacists in Missouri by:
    • Replacing a prior framework that limited pharmacist-performed medication therapy services to those authorized by a statewide order.
    • Authorizing pharmacists to prescribe certain medical devices.
  • The bill aims to give pharmacists a greater scope of practice in collaboration with the State Board of Pharmacy and the State Board of Registration for the Healing Arts, with rules to be developed jointly by these boards.

Key provisions and changes

1) Medication therapy services
- Repeals current language that limits influenza, group A streptococcus, and COVID-19 medication therapy services to a statewide standing order.
- Replaces with authority for a pharmacist who holds a certificate of medication therapeutic plan authority to provide these medication therapy services pursuant to rules established by the boards (Board of Pharmacy and Healing Arts Board).
- Requires joint rulemaking by:
- Missouri State Board of Registration for the Healing Arts
- Missouri Board of Pharmacy
- Rules to be written under the standards of Chapter 536 (Administrative Procedures) and become effective only if compliant with 536 and 536.028.
- This provision is nonseverable with Chapter 536; if the legislature’s rulemaking oversight powers are struck down, the authority and rules related to this section would be invalid.

2) Authority to prescribe medical devices
- Introduces authority for pharmacists to prescribe medical devices.
- Defines “medical device” to include equipment meeting these criteria:
- Classified by FDA as Class I or II under 21 U.S.C. §360 and related regulations (21 CFR Parts 860–892)
- Primarily used to serve a medical purpose
- Generally not useful to an individual in the absence of illness or injury
- Appropriate for home use
- Requires joint rulemaking by the Healing Arts Board and the Board of Pharmacy to implement this device-prescription authority.
- Rules to be developed within six months of the act’s effective date.
- As with the medications provision, any rules must comply with Chapter 536, and the nonseverable nature of the act means rulemaking authority could be void if certain constitutional oversight provisions are held unconstitutional.

Who would be affected

  • Pharmacists holding a certificate of medication therapeutic plan authority: would gain clarified authority to provide specified medication therapy services under jointly established rules, replacing the current statewide order framework.
  • Pharmacists generally: could gain new authority to prescribe certain medical devices, expanding the range of items they may prescribe directly.
  • The State Board of Pharmacy and the State Board of Registration for the Healing Arts: jointly responsible for drafting and implementing the new rules.
  • Patients in Missouri: could experience broader access to pharmacist-driven care for select medications and home-use medical devices.

Procedural and timeline aspects

  • Rulemaking:
    • Medication therapy services: rules to be jointly promulgated by the Healing Arts Board and the Board of Pharmacy; effective only if compliant with Chapter 536.
    • Medical device prescribing: rules to be jointly promulgated, with a six-month deadline from the act’s effective date.
  • Sunset/invalidity safeguards:
    • The act includes nonseverable provisions tying rulemaking authority to constitutional compliance; if the general assembly’s powers to review or delay rules are deemed unconstitutional, the rules and authority established after August 28, 2023 (for medication therapy) or after August 28, 2026 (for device prescribing) could be invalid.

Effective date and status

  • Introduced and referred in May 2026; details indicate an intent to implement new authorities through subsequent rulemaking.
  • Related to SCS SB 878 (2026) as a similar measure.

If you’d like, I can add a quick comparison to current Missouri law or outline potential implementation challenges and stakeholder considerations.

Compiled from official sources — confirm details with the bill’s official record.

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