Capitol Report 9/11/2026

Missouri News Network: Statehouse News for MPA Members

This report is written by Missouri School of Journalism students for publication by MPA member newspapers in print and online.

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Missouri News Network this week focused on two important stories: court rulings that finally settled on what congressional map will be used in the November elections and a deep look at the impact of prescription benefit managers on pharmacies and residents in rural areas.

If you have thoughts or questions, contact Fred Anklam at anklamf@missouri.edu.

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THURSDAY

High court ruling clears use of 2022 congressional map

By Jae Jepsen, Jordan Davis and Anika Austvold, Missouri News Network

JEFFERSON CITY — The U.S. Supreme Court cleared the way Thursday for the existing 2022 state congressional map to be used in the November election.

The action came in response to a federal district court judge’s ruling Tuesday that ordered Secretary of State Denny Hoskins to use a gerrymandered map passed a year ago.

Hoskins followed up by ordering county clerks to use the 2025 map, acting against a Missouri Supreme Court ruling issued a week ago that the map had never been valid.

Hoskins was summoned to the state Supreme Court on Thursday morning to explain why he should not be held in contempt for ordering the 2025 map be used. But Hoskins announced during a recess that he was directing local election authorities to use Missouri’s 2022 congressional map in November.

The Missouri Supreme Court ultimately held Hoskins in contempt Thursday for violating its previous order but announced it was satisfied with his move to use the 2022 map and withheld punishment.

Hoskins maintains that his decision to change was not motivated by the threat of repercussions, but a response to the U.S. Supreme Court decision earlier in the morning. The state high court placed a stay on the federal judge’s order, taking the federal judiciary out of the matter for now.

“The only law and directive that we have right now is from the Missouri Supreme Court, and the Missouri Supreme Court says that the 2022 map is in effect,” Hoskins said.

Prosecuting Attorney Chuck Hatfield represented Richard Von Glahn of People Not Politicians, the group that opposed the 2025 map and sought a public referendum before it could be used in an election. Hatfield said he sees the state high court’s decision as a victory.

“It’s really important today that the judiciary sort of held tight against, what I consider, an attempt by Secretary of State Hoskins to alter what is the law and has always been the law,” Hatfield said.

However, Attorney General Catharine Hanaway stipulated that, while the current situation strongly suggests the 2022 map will be used, there is still room for further litigation. Namely, she says the 2025 map could be used if the U.S. Supreme Court makes an order directing it.

The federal Eighth Circuit Court of Appeals is remaining active in the case, ordering an emergency hearing on the issue for Sept. 17.

“It’s very confusing, almost unprecedented, even in very complicated election law history,” Hanaway said.

Before Hoskins ever appeared in court, the dispute prompted a response from 14 Republican members of the Missouri General Assembly.

The lawmakers sent a letter to the Missouri Supreme Court threatening to seek impeachment proceedings against justices if Hoskins were held in contempt. They argued the court would be disregarding federal law by enforcing its order while a conflicting federal court order was in place.

“Should Secretary Hoskins be held in contempt, we will petition the Speaker of the House and legislative leadership to begin impeachment proceedings against the responsible members of this Court for willful neglect of duty, incompetency, and misconduct under Article VII, Sections 1 and 2 of the Missouri Constitution,” the lawmakers wrote.

The letter was signed by Republican Sens. Joe Nicola, Brad Hudson, Ben Brown, Jamie Burger, Curtis Trent, Rick Brattin, Adam Schnelting, Jason Bean and Jill Carter, along with Republican Reps. Jeff Myers, Chad Perkins, Mike McGirl, Bob Titus and Hardy Billington. None offered additional comment.

Notably absent from the letter’s list of supporters was Republican Rep. Bob Onder, a fierce proponent of the 2025 map. Onder’s district went through dramatic changes as a result of the change in map, losing 11 counties and gaining five. He said the map debate, at its core, is about voting rights.

“It’s not about me,” Onder said. “It’s about the voters, that 1.2 million voters, including hundreds of thousands, in my district, who are disenfranchised by what the Missouri Supreme Court has done.”

Brattin, the Republican nominee for Missouri’s 5th Congressional District, won the August primary under the 2025 map, which significantly reshaped the Kansas City-based district currently represented by Democratic U.S. Rep. Emanuel Cleaver, extending it into more Republican-leaning areas.

In a Facebook post on Thursday, Cleaver expressed his support for the U.S. Supreme Court’s action in favor of the 2022 map.

“A win for justice. A win for democracy. A win for the people of Missouri,” Cleaver said. “It is my hope that state officials will start following court orders and end this shameful attempt to break Missouri law and silence Missouri voters.”

House Democrats sharply criticized the letter, with House Minority Leader Ashley Aune calling it an attempt to intimidate the judicial branch and said the lawmakers could have violated state judicial tampering laws. Missouri law makes it a felony to attempt to harass, intimidate or influence a judicial officer in the performance of official duties.

However, Gov. Mike Kehoe continued to support Hoskins following Thursday’s hearing while suggesting that the legal fight over the map is not yet finished.

“While the reasoning behind today’s Missouri Supreme Court contempt hearings remain questionable, I am proud to stand behind Secretary Hoskins as he continues to serve as Missouri’s top elections authority,” Kehoe said in a statement on X.

“I look forward to the Eighth Circuit’s consideration of the merits of the Missouri First Map and remain confident in the legal process moving forward. Voters deserve certainty and clarity,” Kehoe said.

Hanaway also expressed her support for Hoskins, arguing that he was never in contempt of court.

“He wasn’t held in contempt, and he’s followed the law at every step of the way, and we’ve been proud to defend him at every step of the way, because he’s doing what he swore to do,” she told reporters.

If Missouri voters have any confusion with the altered redistricting, Brianna Lennon, Boone County Clerk, said that citizens can visit boonemo.gov under the voter lookup tool.

Columbia and Boone County are directly impacted by the map changes. During the primary election, voters north of Columbia were included in the 5th Congressional District. Now, they are reverting back to voting in the 4th Congressional District that they have voted in since 2022.

Much of southern Boone County, including areas south of Broadway in Columbia, will be voting in the 3rd Congressional District.

“We know that there is ongoing litigation in the Eighth Circuit, and they are set for oral argument on Sept. 17, and we have to send out ballots to our military and overseas voters on Sept. 18, so we will be following closely to see what the Eighth Circuit decides, but as it stands, we will be using the 2022 map as we prepare for the election,” Lennon said.

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Rural areas see pharmacies close, access to medicine diminish

By Laine Cibulskis, Missouri News Network

Editor's Note: This is the first of a two-part series examining access to rural pharmacies and the role of pharmacy benefit managers in Missouri.

Eight years ago, Mike Burns heard three dreaded words from his doctor: you have cancer. He had more questions than answers.

Am I going to see springtime?

Am I going to get to see grandkids who have not yet been born?

Am I going to get to see Christmas?

As part of his treatment plan, Burns was prescribed capecitabine, an oral chemotherapy drug. Battling cancer would be a challenge, but at least getting his medication wouldn’t be: Burns owns a chain of pharmacies, and capecitabine is on the shelf at his hometown store in Garnett, Kansas.

But when he went to fill his own prescription, it was rejected.

The cancer drug Burns tried to fill was considered “specialty” by the company that AuBurn Pharmacy used to manage prescriptions for its own employees. Even though he could touch the bottle in his own store, he had to obtain his prescription by mail order.

It took over a week to arrive on his doorstep.

“It’s no different than when you give someone your credit card and it comes back declined. Do you know the feeling that you have?” Burns said. “... Imagine that’s your healthcare and it’s your life depending on it.”

The specialty mail order pharmacy Burns had to use was designed for patients who need complex therapies and more personal care. But for the nine months he took capecitabine, Burns said he received no calls checking in on his treatment.

As a patient, Burns didn’t have to pay for the drug when it was sent by mail. But as the business owner and a pharmacist, he saw his company’s health plan being charged more than he knew the drug should cost. Filling his prescriptions locally would have saved his own health plan over $5,000.

“They force (patients) to go to specialty where then they jack the price up, they inflate it, and they keep the difference” Burns said. “... That is what happens every day.”

Long drive times, limited access

For many Americans, a crucial part of their healthcare service no longer goes through a local pharmacist or a doctor. There is a hidden level of control that can dictate what medication you can have, where you get it, when you get it, and how much you pay for it.

That’s the pharmacy benefit manager. These corporations were created to look out for patients, serving as a mediator of sorts between insurance companies and pharmacies.

For decades, employers used these pharmacy benefit managers to verify drug benefits and process prescription claims with the intent to drive down healthcare plan costs for the patients they insure.

But as time has passed, the relationship between pharmacies, benefit managers and insurance companies has changed. Now some PBMs are owned by big healthcare companies. The largest three benefit managers control nearly 80% of the prescription drug claims in the United States, according to the Federal Trade Commission.

Pharmacy benefit managers contract with employers, insurance companies and government programs across the nation to create drug plans for patients, but critics say the savings skew toward the PBM, not the patient, the pharmacy or the employer.

“People don’t understand how the price they pay or their access to a pharmacy is actually determined by this murky hidden thing in the background,” said Abe Funk, a pharmacy owner based in Southeast Missouri. “... As people begin to see that a little bit, they’re like, ‘Wait, wait, why are they making billions of dollars, and I’m paying all this for my drugs?’”

As PBMs have evolved, so has the world around them: independent pharmacies were more than twice as likely to close than chain stores from 2010 to 2021. Drug prices rose three times faster than inflation in the 2010s.

And in Missouri, more than 55,000 residents have at least a 30-minute roundtrip drive to reach a pharmacy.

This summer alone, at least two more independent pharmacies closed in Missouri. One had been serving customers for 185 years.

But even with a pharmacy in town, patients are often steered to the pharmacy their PBM controls, not the pharmacy of their choice.

“If you got two pharmacies in town and the PBM owns one of them, who do you think is going to get the more fair deal?” said state Rep. John Hewkin, a Republican from Cuba and former pharmacist working on PBM regulation in Missouri.

To save money, health plans may favor pharmacies like Walgreens that have large networks, or pharmacies like CVS that are directly owned by a pharmacy benefit manager. This means that Missourians in small towns without chain pharmacies can face longer drives to get their medication.

Once Burns’ cancer abated, he ended his company’s contract with its PBM, Optum Rx, which is owned by United Healthcare, a major insurance company.

AuBurn now uses a “transparent PBM,” MaxCare, which doesn’t have an ownership structure in which an insurer controls the benefit manager.

“The reality is when we get PBM reform … we can maintain access to your local pharmacy, which is your most successful healthcare provider and the lowest cost. Because if we go away, who’s left? The PBMs,” Burns said.

In May, Optum Rx announced a change to its pricing structure. Under the new model, the PBM’s clients — which include employers, insurance companies and government programs — will have transparency into Optum Rx fees, and the company will disclose payments it receives from drug manufacturers, per a company news release.

“It’s not nearly enough to cover our costs. And they know that,” Burns said. “... It sounds good, but if you really read into the contract, that’s not what they’re going to do. The overall reimbursement is still far below what the average pharmacy needs to be sustainable.”

No choice

Greg Alexander’s life was at the mercy of a rocket-propelled grenade. It hit his tanker in Iraq, the blast melting into the left side of his body. He lived, but his health is still not fully under his control 13 years after his honorable discharge from the military.

Alexander uses Tricare, the health and pharmacy plan for current and former military personnel. Tricare uses Express Scripts to manage pharmacy benefits for patients.

Alexander lives with his family in Camdenton. The Ozark town boasts five pharmacies, but Alexander can only go to one chain pharmacy under his Tricare plan.

“There’s no reason we shouldn’t be able to go out and just pick a pharmacist or a pharmacy. … It puts our fate completely in whatever pharmacy, whatever pharmacist we get thrown on by Tricare,” Alexander said.

Alexander used to be a patient at the AuBurn Pharmacy in town under the care of pharmacist Brittany Domagalski. When his prescriptions were sent to AuBurn, Domagalski would fill them and send Alexander a text when they were ready. Pickup was more flexible than at his current pharmacy: he could stop by AuBurn up to three days before he ran out of medicine.

“We were counting our blessings that we stumbled upon them, because we had just never been treated so kind and caring and respectful,” Alexander said.

Alexander could go through Express Scripts to get some of his prescriptions mailed to his doorstep.

“My wife and I are contemplating getting the mail (order), but everybody that we’re talking to about the mail one (says) that that’s really unreliable as well,” Alexander said. “And if they don’t send it in time, then you’re still at the mercy of then having to go to the pharmacy and tell them that those mail (order) prescriptions didn’t arrive in time.”

“We’re scared about doing that as well. But I think that that might be our only avenue here because it’s just too much for us to make these constant trips to and from the pharmacy,” Alexander said.

His family ultimately decided against the switch.

With only 29 pharmacies, AuBurn’s smaller size means it has less power to negotiate contracts. Eventually, AuBurn lost so much money from filling Tricare and other Express Scripts plans that it ended its contract with the company.

AuBurn’s contracts with pharmacy benefit managers often leave the pharmacy losing money for each prescription filled, as reimbursements from PBMs can fail to cover the cost.

National pharmacy networks often have more leverage to negotiate contracts with benefit managers like Express Scripts, such as Walgreens, which has approximately 8,000 locations in the U.S.

Behind the counter at AuBurn, the pharmacy computer keeps a provisional tally of how much the store earns or loses from each prescription. But on the job, Domagalski’s focus often turns to sorting out pharmacy coverage issues for her patients.

“It is a constant battle trying to get things covered for patients, and in a timely manner too, because when people need something it’s because they have something going on, whether it’s an illness, a chronic disease, something acute,” Domagalski said.

Kelcey Blair worked at Express Scripts, headquartered in St. Louis, for over a decade. She eventually became the company’s vice president of clinical and trend solutions. Blair started in 2009 as a pharmacist at the company, but over the years, more promotions came with more access to financial discussions.

“The more I saw, the more I learned,” Blair said, “and the more it forced me to reflect on myself and my integrity and to say, ‘Is this really what I want to be a part of?’”

Blair said one of the reasons why she left was because the closure of independent pharmacies was accepted as a part of Express Scripts’ growth.

She was raised in Gideon, a small town in the Bootheel. Blair grew up seeing her neighbors struggle with healthcare.

“I’ve actually seen it, where others, I don’t think that they’ve ever really had to contemplate, ‘Hey, that’s my aunt that had to drive just another, you know, 20 miles, which may be another 45 minutes out of her way, just to go pick up her medication.’ Oh, and by the way, that’s every single month. That’s not just one time. That’s now the standard for this person,” Blair said.

Gideon’s only pharmacy closed last March.

No money, no pharmacy

Blair’s mother, Marinda Thornbrough, used to work for Dick Jones in the early 1970s at Gideon Pharmacy, which was owned by the town’s Gideon-Anderson Lumber and Mercantile Company. The store sold sodas and sandwiches. If someone walked in and told Jones their symptoms, he’d find the best solution and compound a drug or a salve to help.

At the time, most people in America didn’t have a pharmacy benefit manager to oversee their care. They just walked in.

“It was a totally different time,” Thornbrough said. “You could walk wherever you needed to go.”

The pharmacist, who Thornbrough still calls “Mr. Dick,” eventually had to leave the shop after he got cancer. Without another pharmacist to take over, the company shut down the pharmacy.

In its heyday, Mayor Lindal Cossey said Gideon had three grocery stores, three gas stations, a Western Auto and the Gideon-Anderson company that manufactured beverage crates. When Gideon-Anderson Lumber and Mercantile Company shut down in 1978, many of those who could afford to go left too.

“We’re just like any other Southeast Missouri town. No money,” Cossey said.

Thirty years after the company left, Funk, a pharmacist and business owner, decided to bring a pharmacy back to Gideon. He opened a location right in city hall in 2015.

Funk and his wife, Emily Funk, own John’s Pharmacy, a small chain that operates in Southeast Missouri. The Funks took over the business from Emily Funk’s father. The Gideon location was the first pharmacy Abe Funk opened on his own, despite knowing the location wouldn’t be a money-maker from the start.

Pharmaceutical care was now a walk away for many of the town’s approximately 662 residents. And if they couldn’t walk, the pharmacy usually had a delivery car ready to go. The location was also convenient for some residents in surrounding areas, such as Clarkton.

Funk knew he would be helping patients in need.

“‘I’m not dealing with people down there who are driving Escalades around. Who cares if they have to drive an extra 20 minutes to get their prescriptions?” Funk said. “These are people who don’t have gas money, if they have a car. Who are really struggling, who are making not much of anything if they’re making anything … these are people too.”

Funk is no stranger to these kinds of challenges: as a kid growing up in Georgia, his parents would say they weren’t poor. But Funk remembers coming home some days with the water off or the power off.

“We didn’t know any different because everyone around us lived the same way. But I remember those things … I know there’s people here that don’t have water. Don’t have power. And I relate to that,” Funk said.

Funk said the pharmacy was embraced by the residents, but never made enough to stay afloat. Ultimately, low reimbursement rates from PBMs combined with fewer customers made the location untenable.

“The last few years it just got worse and worse and worse to the point that my other pharmacies were subsidizing that one just to keep it open,” Funk said. “You can only do that so long.”

The hardest part for Funk was having to leave behind the people the pharmacy served.

After over 20 years in the industry, Funk has watched as fewer pharmacy benefit managers take over more of the market. With a small number of large companies controlling how pharmacies can be reimbursed, Funk said there’s no room for negotiation for small independent operations like his.

Gideon is in the middle of three towns about 10 to 15 miles away that have pharmacies. But even then, care at the closest option isn’t guaranteed. Cossey goes to the Walgreens almost an hour away to fill his prescriptions through his Tricare plan.

“It makes it that much harder for us,” Cossey said.

Through Tricare, Cossey could fill his predictions at the Delta Regional Pharmacy in Malden, but he says one of the problems of finding a pharmacy is that “you just never know until you walk in the door.”

What the patient doesn’t see

Technically, a patient using a pharmacy benefit manager plan could fill their drug at any pharmacy, if they wanted to pay full price without their insurance benefit. But the cost of getting care at an “out-of-network” pharmacy can add up.

For example, in Columbia, a patient on a Wellcare Medicare plan could get a commonly prescribed diabetes medication, metformin, for free at CVS, Walgreens or through mail order. But at Flow’s, an independent pharmacy, or Walmart, one year of that one drug would cost $180.

“If you’re on 10 drugs a month, which is not uncommon for our senior population, are you going to pay an extra $200 to $500 every single month just to come here?” Funk said. “No. No, no one’s going to do that. Most people can’t afford to do that if they wanted to.”

But proponents of PBMs say creating a pharmacy network can help employers push down health plan costs.

Blair, the former Express Scripts employee raised in Gideon, said that a lot of times, cost savings for employers come from not paying pharmacies very well.

“It took me quite a long time to figure out, oh, when you brag as a PBM about doing these things that sound good, you kind of forgot to explain that to make an omelet, you have to crack a lot of eggs. And in this analogy, the eggs are the pharmacies,” Blair said.

An Express Scripts spokesperson took issue with that.

“We want patients to have broad access to a wide range of thriving pharmacies, and fundamentally reject any assertion to the contrary,” the spokesperson said. “… Pharmacies that serve rural or underserved communities are eligible for enhanced reimbursements recognizing their critical role as a front door to care. This approach is intended to move away from volume‑driven economics and toward rewarding care, access, and outcomes.”

Express Scripts’ IndependentRx Initiative was launched in 2023 to increase reimbursements to some independent pharmacies. To qualify, the pharmacy must be the only pharmacy within 10 or more miles from a patient using Express Scripts, and must be unaffiliated with a drug wholesaler.

Blair said the pressures benefit managers face from clients — the employers — are often understated. Large health plans like Blue Cross Blue Shield of Illinois can serve upwards of 9 million members.

“You could be a mega client like that, that brings in millions of bucks that they themselves have a lot of leverage that tells the PBM, ‘I need better pricing. You need to go press on your pharmacies harder.’ And so, as a result, the PBM will do that,” Blair said.

Mark Dalton is the Missouri political director for the Mid-America Carpenters Regional Council. The union currently uses Express Scripts to manage pharmacy benefits for its members. The union’s plan benefits include a cost breakdown dashboard for members.

He said the union benefits from working with Express Scripts, especially when it comes to cost savings and plan customization.

“The PBMs offer several different ways to provide coverage and to maximize customize our benefits for our members,” Dalton said. “They lay out all of the different options and we work with them on specific things that we want to see in our plan.”

Dalton said the mail order program the union participates in for specialty drugs saves their health plan over $5 million every year.

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No state law polices gun storage, despite leading fatality among suicide attempts

By Erin Hynes, Missouri News Network

In Missouri, roughly 752 people die by firearm suicide each year.

While firearm suicide is not the most common way, it is the most fatal. The American Academy of Pediatrics says that firearm attempts are 91% fatal, compared to attempts involving drug overdoses, which are 23% fatal.

No law, limited protections

Despite the high risk of fatalities, no state law governs firearm storage in Missouri.

Only 16 states and Washington, D.C., have laws regarding safe gun storage, according to the American Academy of Pediatrics.

Missouri was ranked the 10th-highest in gun-death rates in 2024, with 11.6 per 100,000 Missouri residents dying from firearm suicide, according to Johns Hopkins University’s Center for Gun Violence Solutions.

Illinois and Iowa, which border Missouri, rank 33rd and 35th for gun death rates, according to the data.

During the 2026 legislative session, Sen. Barbara Washington, D-St. Louis, sponsored Senate Bill 1171, making unsafe firearm storage a Class C felony in Missouri. Washington’s bill never reached the Senate floor.

Rep. John Black, R-Marshfield, sponsored House Bill 2763 last session, which would have provided permanent funding for Missouri crisis services, such as 988, the state’s suicide and crisis lifeline. HB 2763 received support from the American Federation for Suicide Prevention and other representatives, like Gregg Bush.

Missouri state Rep. Gregg Bush, D-Columbia, said dwindling mental health resources in the state have made it more important to reach out to loved ones.

“Sometimes the people that need the most help are the ones that don’t reach out... so we have to do the work to keep our friends and family safe,” Bush said.

Advocates like Lauren Ross, Missouri Chapter Board and Advocacy chair with the American Foundation for Suicide Prevention, stressed that firearm safety is there to put something between the thought and the action.

“The goal behind safe firearm storage isn’t to take the firearms away; it is to put time and distance between the thought and the actual lethal means themselves,” Ross said.

A fatal gap

Without a statewide policy, some Missouri organizations have stepped up to help.

The Columbia Chapter of the American Foundation for Suicide Prevention will host its annual Out of the Darkness Walk on Oct. 25. All funds from the walk support advocacy, education and research efforts for communities across Missouri.

Anyone who is struggling can reach out to any AFSP chapter leader across the nation, who can also help provide a gun safety lock. Gun locks are threaded through a firearm to prevent it from being loaded or fired until the mechanism is unlocked, essentially disabling the gun.

Another accessible option for gun locks is any Veterans Hospital across Missouri.

Harry S. Truman Memorial Veterans’ Hospital, located in Columbia, is one of four major Department of Veterans Affairs (VA) hospitals in Missouri. Other VA clinics are spread throughout the state, including in Sedalia, Camdenton and Jefferson City.

According to the VA’s website, gun locks are a “way to put time and space between a moment of despair and a permanent decision.”

Last school year, Columbia Public Schools officials met with representatives from the Columbia Police Department to update the student handbook with information on secure firearm storage.

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WEDNESDAY

Efforts to change the way pharmacies are regulated have failed in Missouri

By Laine Cibulskis, Missouri News Network

Editor's Note: This is the second of a two-part series examining access to rural pharmacies and the role of pharmacy benefit managers in Missouri.

Advocates have been trying to pass pharmacy benefit manager reform in Missouri for years.

These benefit managers serve as the middlemen between insurance companies, drug manufacturers and pharmacies to help negotiate drug costs and manage benefits for patients.

Critics say the system needs an overhaul: Prescription costs are rising, independent pharmacies are closing in communities across the country and many PBMs are owned by large health care systems that also control insurance companies and national pharmacy networks.

Despite success in Kansas, Missouri’s latest rendition of PBM reform failed in this spring’s legislative session. The legislation would have strengthened state oversight of PBMs to help improve patient costs and support independent pharmacies. Previous bills had a habit of dying in the Senate, if they made it to the chamber in the first place.

It’s the seventh year in a row PBM reform has failed in Missouri.

In Arkansas, legislation to ban anti-competitive practices for PBMs was signed into law in 2025. Missourian Loretta Boesing traveled there to testify in support of Arkansas’ legislation last year. Boesing, the Arkansas Pharmacists Association’s Patient Advocate of the Year, has been speaking up for patients since 2018.

“I don't want to see another year go by and changes not being made at the state and federal level. We need more to protect them,” Boesing said. “I can't rest.”

Boesing’s son Wesley went into transplant rejection after taking mail order drugs that had been left in the Missouri heat. Boesing’s insurance had directed the family to its PBM-owned mail order pharmacy. She says it is still a fight to get Wesley’s medications filled in person at her local pharmacy.

State Rep. John Hewkin, a Republican from Cuba and a pharmacist for nearly four decades, was the primary sponsor of the Missouri House’s PBM regulation bill.

The freshman legislator with 19 grandchildren spent much of his first year in office analyzing why PBM legislation keeps failing.

“I wouldn’t believe when I ran for office that you could have a problem that you could write legislation for, and the very people who caused the problem, you have to negotiate with,” Hewkin said.

He’s been on both sides, having owned an independent pharmacy and working for PBM-owned chains like CVS.

“I'm not saying that (PBMs are) terrible. … What this bill backs up is that the way they audit the pharmacies is unfair, the way they pay the pharmacies is unfair, the contracts are unfair. We've got to do something to fix that,” Hewkin said.

Some see savings with PBMs

The Mid-America Carpenters Regional Council and the Missouri Chamber of Commerce spoke against the proposed Missouri legislation.

Mark Dalton, the union’s Missouri political director, said that the union’s current setup allows cost savings to flow into a fund that allows the union to lower overall plan costs. The legislation would have let cost savings flow directly to the patient.

“On the surface, it sounds great to save money for the individual that is filling the prescription, but in a plan like ours, we give those discounts back to our health and welfare fund so that it is spread out evenly amongst all of our members and their family that are covered on our plan,” Dalton said.

In February, Congress passed federal PBM reform as part of its appropriations act. It aims to lower costs for medications and preserve healthcare access. Medicare, which also uses PBMs to manage drug benefits, will be provided funds to investigate pharmacies’ complaints of PBM mistreatment under the law.

Implementation of the federal reform will take at least two years.

“Sadly, it's not going to be near soon enough for the majority of pharmacies that are already struggling,” said Mike Burns, owner of the AuBurn Pharmacy chain.

Before the federal change, Cigna, the major healthcare organization that owns pharmacy benefit manager Express Scripts, announced that the company was debuting a new PBM model that aims to help lower drug costs for patients.

“Our new pharmacy benefit model was built to strengthen community pharmacy viability by reimbursing pharmacies based on their actual drug acquisition costs and paying more for the clinical services pharmacists provide every day, from medication counseling to health screenings,” a spokesperson from Express Scripts said.

Independent pharmacists such as Abe Funk aren’t convinced the changes will help long term.

“I can't afford a full-page spread in the Wall Street Journal, but two or three times a week, there's a full page of the back of the Wall Street Journal with Express Scripts talking about how good they do for healthcare for everybody,” Funk said. “What we found is that when they say they're going to change this piece, they just come in and manipulate somewhere else.”

'We'll have to fight for them'

The Federal Trade Commission, under both the previous and current presidential administrations, has recognized that as pharmacy benefit managers merge with other areas of healthcare, patients are paying more and independent pharmacies lose the leverage to negotiate reimbursements.

The FTC and Express Scripts settled a lawsuit in February, in which the FTC alleged Express Script’s conduct artificially inflated insulin drug prices.

Before the settlement, Express Scripts had filed a lawsuit against the FTC for its July 2024 report on the PBM industry, alleging false and misleading claims about benefit managers in the report.

“The PBM is designed to force down the cost of the drugs, and they do that by leveraging volume and saying, ‘We represent all these lives.’ If you want your drug covered on these plans, you need to offer a better deal to our clients,” said Phil Christofanelli, who represents 20 pharmacy benefit managers through the Pharmaceutical Care Management Association.

That kind of concentration can give larger benefit managers more leverage but can hurt smaller players in the process.

Not all patients see a downside: Bill Rhoads walked into AuBurn’s Camdenton location holding his wife’s OptumRx benefits card that would pay for his baking soda tablets and insulin pen needles.

“It’s very beneficial. Very good. Her company loads the card so much every year, and it rolls every year. It’s really nice.  … This is like $10 just for the pills, and these are $18. It don’t come out of my pocket,” Rhoads said.

But Loretta Boesing isn’t keen on trusting the system, after more than a decade of treatment for her son’s liver transplant. “What these PBMs do is all for money. … They will just use my son's life for profit in every way they can figure out,” she said.

The family is hoping to plan a trip to Montana so Wesley can get a glimpse of Canada. He said he wants to move there one day, to escape the Missouri heat and its healthcare system. But the pilgrimage may have to wait: Wesley’s labs are showing warning signs after he went into rejection again in October.

“So … I … This is where we're stuck for now,” she said on a Saturday after her work shift. “We just tried to fill his meds and, you know, right now they're showing it's not even going to be covered. We'll have to fight for them.”

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Congressional map confusion continues as map is appealed to U.S. Supreme Court again

By Jordan Davis and Anika Austvold, Missouri News Network

Conflicting orders from the Missouri Supreme Court and a federal judge have left the state’s congressional map in limbo with uncertain timing on when the issue will be resolved.

One thing is certain: Voters will see a referendum on the new congressional map passed in 2025 on their November ballots, and they can decide if they approve.

“The question is, ‘What district are they going to be voting in when they vote in November?’” asked Jayne Woods, an associate law professor at the University of Missouri. “That, I don’t think, has been answered yet.”

Others who study state law agree.

“It’s likely still to be a bumpy ride as we sort out all of these issues,” Dave Roland, senior legal advisor for the Freedom Center of Missouri, told KOMU 8.

“I think it’s very difficult to read where we’re going to go legally with this because I think there are really valid arguments on either side,” said Scott LaCombe, assistant professor in the Truman School of Government and Public Affairs.

The dispute dates back to September 2025, when the Missouri General Assembly passed House Bill 1 to redraw the state’s congressional districts in hopes of adding an additional Republican-leaning district.

Opponents of the new map launched an effort to put it before voters through a referendum. More than 300,000 signatures were collected and submitted to Secretary of State Denny Hoskins in December 2025.

Hoskins rejected the referendum on the last day possible, Aug. 4. This was the same day Missouri held its primary election using the HB 1 districts.

The Missouri Supreme Court ruled Sept. 3 that the state’s new congressional map was never legal because a referendum petition challenging it was legal, sufficient and timely. The court ordered the state to use its preexisting 2022 congressional districts in November.

“This has been a moment of, like, crisis that people following this have been seeing for the last nine months that the court has repeatedly said if we get enough signatures, we are going to go back to these 2022 maps,” LaCombe said. “Hoskins used the full amount of time that he was legally allowed to make that decision.”

Following the state Supreme Court ruling, Hoskins asked the U.S. Supreme Court to temporarily block the state court’s decision. Justice Brett Kavanaugh denied that request Tuesday, seemingly leaving the Missouri Supreme Court’s order in place.

But shortly afterward, a federal judge in St. Louis ordered the opposite. U.S. District Judge Stephen Clark issued a temporary restraining order preventing Missouri from using any congressional map other than the new HB 1 districts in November.

Clark was ruling in a suit brought by two candidates for Congress — U.S. Rep. Bob Onder, R-St. Charles, and state Sen. Rick Brattin, R-Harrisonville — arguing that federal voting rights would be violated if different maps were used for the primary and the general election. The judge’s ruling is temporary — holding things in place for 14 days.

The result is two court orders pointing Missouri election officials in different directions. The Missouri Supreme Court has prohibited Hoskins from using HB 1, while the federal district court has prohibited him from using anything other than HB 1.

Woods said the two courts reached their decisions by considering different legal questions. Roland and LaCombe agreed. The Missouri Supreme Court’s decision focused on Missouri law, while Clark considered the federal constitutional implications of switching maps between the primary and general election.

“It’s almost like two ships passing in the night,” Woods said. “We got the federal court ruling on federal constitutional law, state court ruling on state constitutional law.”

There is no simple answer for which court’s order should take precedence, Woods said.

Federal courts take precedence in many legal conflicts because of the U.S. Constitution’s supremacy clause, she said. But federal courts also generally try to avoid interfering with state law matters under principles of federalism.

Hoskins, responding to the federal court, told county clerks across the state that the new gerrymandered maps will be used instead of the preexisting maps, going directly against the state Supreme Court and the U.S. Supreme Court decision not to get involved.

State law set 5 p.m. Tuesday as the deadline to finalize the state ballot. But Roland said he thinks that is not so firm.

“The Missouri Supreme Court seemed to indicate that they did not see that as a hard and fast limit as far as changes that can be made … in practice, there may be some flexibility, and we’ll just have to see exactly how it plays out,” he said.

Hoskins is set to appear before the state’s highest court Thursday over whether he violated its order. That’s if a federal district court doesn’t agree with his plea to block the state Supreme Court from punishing him.

Taking to the social media website, X, Hoskins stated, “I look forward to my day in court.”

Meanwhile, the federal ruling requiring Missouri to use the new map was appealed by the People Not Politicians organization that originally challenged the new map in 2025. While that appeal was rejected, the group appealed to the U.S. Supreme Court later Wednesday.

“I do think that whatever final decision comes down, likely out of the federal courts, that’s probably going to determine how the ballot is structured in November in Missouri,” Roland said.

LaCombe said the controversy could potentially provide an opportunity to adjust the timing on when the petition initiatives in the future would be certified. Rather than having ballot initiatives decided on the primary election date, it would be wise having a buffer period for the secretary of state to decide whether or not to certify signatures, he said.

Until then, the legal fight leaves Missouri voters waiting to find out which congressional districts will ultimately be used in November.