Summary of the Truly Agreed Version of the Bill




This bill establishes the Missouri Electronic Prior Authorization

Committee to facilitate, monitor, and report on Missouri-based

efforts to contribute to the establishment of national electronic

prior authorization standards that generally relate to the

process of obtaining prior approval from an insurer for certain

services or medications. The efforts must include the

establishment of a pilot program and the study and dissemination

of information from the National Council on Prescription Drug

Programs. The committee must advise the General Assembly and the

Department of Insurance, Financial Institutions and Professional

Registration if there is a need for administrative rules to be

promulgated by the department as soon as practically possible.

The 19-member committee is to include members of the General

Assembly, executive branch directors, representatives from the

pharmaceutical and healthcare industries, and a patient advocate.

The staff of the department must provide assistance to the

committee. The duties of the committee, specified in the bill, include the preparation of an annual report to the General

Assembly and Governor on the committee’s progress and plans for

the next year until national standards are established or the

provisions of the bill expire, whichever is sooner. The first

report must be completed before January 1, 2013. Upon the

adoption of national standards, the committee must prepare a

final report to the General Assembly and the Governor that

identifies the appropriate Missouri administrative regulations,

if any, that will need to be promulgated in order to make those

standards effective as soon as practically possible and whether

there are any necessary legislative actions.

The department and the committee must recruit a Missouri-based

pharmacy benefits manager doing business nationally to volunteer

to conduct an electronic prior authorization pilot program in

Missouri that must be operational by January 1, 2014. The

manager conducting the pilot program must ensure that there is an

adequate number of Missouri licensed physicians and an electronic

prior authorization vendor capable and willing to participate in

a Missouri-based pilot program. The department and the committee

may provide advice or assistance to the manager conducting the

pilot program but cannot maintain control or lead with the

direction of the pilot program.

The provisions of the bill expire six years after the effective


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