SB 1340 - Under this act, a health carrier, a pharmacy benefits manager, or an agent or affiliate of such, shall not discriminate against a covered entity, as defined in the act, including by reimbursing the covered entity for a quantity of a 340B drug in an amount less than it would pay similarly situated non-covered entities for such drugs, imposing different terms and conditions as compared to similarly situated entities, refusing to cover 340B drugs or discriminating in reimbursement for 340B drugs, and other situations described under this act. The Director of the Department of Commerce and Insurance shall impose a civil penalty on any health carrier, pharmacy benefits manager, or agent or affiliate of such, that violates this provision, not to exceed $5,000 per violation per day. This act is identical to HCS/SB 1019, provisions in the truly agreed to and finally passed 878 (2026), SB 841 (2026), provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 2372 (2026), and SCS/HB 2146 (2026), and similar to a provision in SCS/HCS/HB 943 (2025) and HB 784 (2025). TAYLOR MIDDLETON

2026 Regular Session

Missouri bill prohibits insurers and pharmacy managers from paying 340B drug program participants less than other entities, with penalties up to $5,000 daily for violations.

Second Read and Referred S Families, Seniors and Health Committee

Legislative bill overview

SB 1340 prohibits health insurers and pharmacy benefits managers from discriminating against covered entities (primarily hospitals and clinics that participate in the federal 340B drug pricing program) by paying them less for 340B drugs than non-covered entities receive, or imposing different terms and conditions. Violations trigger civil penalties up to $5,000 per day.

Why is this important

The 340B program allows qualifying healthcare providers to purchase certain drugs at discounted federal prices to stretch limited resources. Without protection from discriminatory reimbursement practices, insurers could undermine this program's benefit by paying providers less than standard rates, effectively eroding the savings Congress intended these entities to receive. This directly affects the ability of hospitals and clinics serving vulnerable populations to maintain drug assistance programs and affordable care.

Potential points of contention

Insurance industry costs: Payers argue that preventing them from negotiating lower rates for 340B drugs could increase overall healthcare costs and insurance premiums, as they claim covered entities already receive significant federal discounts

Definition and scope disputes: The bill's reference to "similarly situated entities" may create ambiguity about when discrimination occurs, potentially leading to litigation over comparable circumstances and market practices

Enforcement clarity: The $5,000-per-day penalty structure could incentivize aggressive regulatory interpretation, and stakeholders may dispute whether penalties apply per claim, per patient, per day, or per policy violation