LR 8383
Taxability of Medical Equipment
February 26, 2026
Dear Applicant:
This is a letter ruling issued by the Director of Revenue under Section 536.021.10, RSMo, and Missouri Code of State Regulations 12 CSR 10-1.020, in response to your letter dated January 7, 2026.
The facts presented in your letter ruling request are summarized as follows:
Applicant is an online vendor of novel medical equipment kits (Kits). These Kits are used by physicians' offices, and in some cases compounding pharmacies, to aliquot the drug into small, individual dose syringes which are provided in a closed system bag and syringe tray. These individual doses are prescribed and administered by ophthalmic physicians for patients with Macular Degeneration.
ISSUE 1:
Is Applicant responsible for collecting sales tax on its sales of Kits to physicians' offices?
RESPONSE 1:
Yes. Sales of tangible personal property to physicians' offices do not qualify for a resale exemption. However, if Applicant's Kits are only dispensable by a licensed pharmacist upon prescription of the drug to a patient by a licensed practitioner, then Applicant would not be responsible for collecting sales tax on sales of Kits.
Section 144.020.1, RSMo, provides "A tax is hereby levied and imposed upon all sellers for the privilege of engaging in the business of selling tangible personal property or rendering taxable service at retail in this state."
Section 144.010, RSMo, includes in the definition of "Sale at Retail" this provision: "(i) purchases of tangible personal property made by duly licensed physicians, dentists, optometrists and veterinarians and used in the practice of their professions shall be deemed to be purchases for use or consumption and not for resale..."
Section 144.054.2, RSMo, provides an exemption from sales tax for "chemicals, machinery, equipment, and materials used or consumed in the manufacturing, processing, compounding, mining, or producing of any product..."
Physicians' equipment, such as syringes, needles, and other items used and consumed in delivering the physician's services, which are provided only in the course of that physician's treatment of a patient, and that do not have a marketable value separate from the physician's treatment, do not constitute a "product" for the purposes of Section 144.054.2, RSMo. Interventional Center for Pain Management v. Director of Revenue, 592 S.W.3d 350 (Mo. 2019).
Section 144.030(18), RSMo, provides an exemption from sales tax for "all sales of drugs which may be legally dispensed by a licensed pharmacist only upon a lawful prescription of a practitioner licensed to administer those items, including samples and materials used to manufacture samples which may be dispensed by a practitioner authorized to dispense such samples..."
Applicant sells its Kits to physicians, who then mix and administer the drug contained in the Kits. When a patient visits their physician for treatment, they are seeking the services of that physician to treat their ailment, not seeking a particular drug. Thus, Applicant's sale of Kits does not qualify for an exemption from sales tax under Section 144.054, RMSo. Additionally, Applicant's sale of Kits to physicians does not qualify as a sale intended for resale for purposes of sales tax, per the definition of "Sale at Retail" under Section 144.010.1(13), RSMo. Therefore, Applicant would normally be responsible for collecting and remitting sales tax when selling their Kits to physicians' offices. However, if Applicant's Kits are of the kind of drug that can only be dispensed by a licensed physician upon a patient's receipt of a prescription for the drug from a licensed practitioner, then Applicant would not be responsible for collecting sales tax on sales of Kits under Section 144.030(19), RSMo.
ISSUE 2:
Is Applicant responsible for collecting sales tax on its sales of Kits to pharmacies?
RESPONSE 2:
Yes. See Response 1. However, sales to a pharmacy of Kits which the pharmacy intends to resell are exempt from sales tax if Applicant accepts a Sales and Use Tax Exemption Certificate from the pharmacy in good faith.
Section 144.018, RSMo, exempts from sales tax any purchases made for the purposes of resale if that subsequent sale is itself exempt, for resale, or otherwise subject to a tax in this or any other state.
The Missouri Code of State Regulations 12 CSR 10-107.100(1) provides: "[A] seller that receives and accepts an exemption certificate in good faith is not required to collect and remit tax on a sale covered by the exemption certificate."
Based on the facts presented, Applicant occasionally sells Kits to pharmacies which are then either (1) directly sold to patients at the pharmacy or (2) sold to ophthalmic physicians for use in their practice to treat patients with Macular Degeneration. Since the purchases by the pharmacy are ostensibly intended for resale, Applicant should, in good faith, collect a Form 149 Sales/Use Tax Exemption Certificate from each pharmacy which purchases Applicant's Kits for resale. Applicant is not responsible for collecting and remitting sales tax on sales to pharmacies from which Applicant has accepted a Form 149 in good faith.
This letter ruling is binding upon the Department of Revenue with respect to the Applicant for three (3) years from the date of this letter and is subject only to statutory changes by the General Assembly and to changes in the interpretation of law by the courts or administrative tribunals. If a change occurs, the taxpayer who relies upon an outdated interpretation may be subject to additional taxes, interest and penalties, which may be imposed prospectively from the date of the change. For this reason, the interpretation set forth above should be reviewed on a regular basis. Please note that any change in or deviation from the facts as presented will render this ruling inapplicable.
Should additional information be needed, please contact Legal Counsel Gabriel Barnes, General Counsel's Office, Post Office Box 475, Jefferson City, Missouri 65105-0475, phone (573) 751-0961.
Sincerely,
Trish Vincent