One of the biggest financial pressures facing local governments today is the rising cost of healthcare. For counties like St. Louis County, providing health coverage for public employees — including law enforcement, public works staff, and other essential workers — is a major responsibility. When healthcare costs increase, those increases ripple through already tight local budgets.
Prescription drug costs are a major part of that challenge. Like many large employers, county governments rely on pharmacy benefit managers (PBMs) to help negotiate lower drug prices and manage prescription benefits for employees and their families. PBMs are one of the tools counties use to help control costs and maintain sustainable healthcare plans.
At the same time, lawmakers in Jefferson City are trying to address concerns in the prescription drug system and support local pharmacies that play an important role in communities across Missouri. Neighborhood pharmacies provide vital access to medications, particularly for seniors and residents in smaller communities, and they are an important part of our local healthcare infrastructure.
But reforms aimed at helping one part of the system should not unintentionally shift additional costs onto others — especially the employers and taxpayers who ultimately fund public employee healthcare plans.
Several bills currently moving through the Missouri legislature — Senate Bill 984 and its companion House Bill 1850, along with Senate Bill 968 and its companion House Bill 1975 — raise concerns for large employers like counties and municipalities.
Senate Bill 984 and House Bill 1850 would mandate minimum dispensing fees and limit the tools PBMs use to negotiate lower drug costs and manage pharmacy networks. While intended in part to support pharmacies, those mandates would increase prescription drug spending for employer health plans — including those funded by taxpayers.
Senate Bill 968 and House Bill 1975 would introduce new fiduciary requirements and regulatory mandates that could increase administrative costs and litigation risk for employers managing healthcare benefits.
For counties, higher healthcare costs are not just a policy debate — they are a budget reality. When healthcare expenses rise, local governments must either shift costs elsewhere or find ways to absorb those increases within already limited resources. That can affect everything from infrastructure investment to the ability to support the employees who keep our communities running.
Everyone wants a healthcare system that works better and costs less. Supporting local pharmacies is an important goal. But solutions should strengthen the entire system without simply shifting costs onto local governments, employers, and the taxpayers who ultimately fund these benefits.
As lawmakers evaluate Senate Bill 984, House Bill 1850, Senate Bill 968, and House Bill 1975, it is important to ensure reforms protect access to community pharmacies while also preserving the tools counties and municipalities rely on to manage healthcare costs responsibly.
Thoughtful policy can achieve both goals — supporting local pharmacies while maintaining affordable healthcare coverage for the public employees who serve our communities every day.
St. Louis County Councilman
