Jill Carter, Missouri State Senator for District 32, has announced new legislative proposals aimed at increasing transparency and accountability among pharmacy benefit managers (PBMs) to reduce costs and ensure access to care.
“These bills deliver long-overdue transparency and basic accountability in the prescription drug system so families, pharmacists, and employers stop paying more than they should while patients get the care they need,” said Carter.
Missouri lawmakers have introduced Senate Bill 984 and House Bill 1850 for the 2026 legislative session. These bills seek to address what they describe as abusive practices by PBMs. The proposed legislation includes measures such as requiring greater transparency in claims data, prohibiting copays that exceed a drug’s cost, setting minimum reimbursement rates tied to Medicaid, standardizing PBM audit rules, creating a formal appeals process, and establishing a Critical Access Pharmacy Fund to support essential pharmacies across the state.
According to an interim report from the Federal Trade Commission (FTC) dated July 9, 2024, consolidation has allowed PBMs significant control over drug prices and access. The report states that the three largest PBMs processed nearly 80% of approximately 6.6 billion U.S. prescriptions filled in 2023. The FTC also reported that PBM-owned pharmacies captured substantial specialty drug revenue, including nearly $1.6 billion in excess revenue from two cancer drugs over less than three years.
Missouri plays a central role in the national debate on PBM practices. St. Louis-based Express Scripts is named as a defendant in a federal lawsuit filed by the FTC on September 20, 2024. The lawsuit alleges that Express Scripts, along with OptumRx and Caremark, contributed to rising insulin prices at patients’ expense.
Carter was elected in November 2022 as a Republican member of the Missouri State Senate representing District 32, which includes Jasper and Newton counties. She assumed office on January 4, 2023, serving as Majority Caucus Whip in Senate leadership. Carter has been a resident of southwest Missouri for over thirty years and has experience operating a family farm and engaging in community advocacy.
