HB 1955 requires Tennessee's Commissioner of Commerce and Insurance to publish an annual report by October 1, 2026, detailing alleged violations by pharmacy benefits managers (PBMs) related to delayed reimbursements to pharmacies. The report must include the total number of reported violations, findings from investigations, and penalties imposed for confirmed violations under existing law (TCA §56-7-3124). This directly affects PBMs operating in Tennessee, as they must comply with reimbursement timelines, and pharmacies that may receive delayed payments. The bill mandates transparency by documenting enforcement actions without creating new penalties. The report will be submitted to the General Assembly and made publicly available.
HB 1956 expands protections for cancer patients by removing restrictions on when health insurance plans must cover approved cancer treatments without requiring "step therapy." The bill changes Tennessee law to prohibit health benefit plans from forcing patients to try less expensive treatments first for *any* cancer diagnosis (previously limited to stage 4 advanced metastatic or blood cancers). This directly affects all health insurance plans covering cancer treatment and enrollees diagnosed with cancer, ensuring coverage for approved drugs without prior step therapy requirements. The law takes effect January 1, 2027, for new or renewed policies.
SB 2010, the "Regulate Artificial Intelligence in Health Care Act," requires health insurance companies to have licensed healthcare professionals review AI-driven decisions about whether medical care is medically necessary before denying or delaying treatment. It directly affects health insurance issuers - including TennCare, pharmacy benefits managers, and large insurers - that use AI tools for prior authorization decisions. The bill prohibits AI systems from making final medical necessity determinations alone, mandating that licensed providers evaluate each case based on patient history and clinical details. Violations are considered unfair claims practices, allowing affected individuals to sue for damages, including attorney fees, and the law takes effect July 1, 2026.
HB 1866, the "Regulate Artificial Intelligence in Health Care Act," requires health insurance companies, pharmacy benefits managers, and state health programs like TennCare to have a licensed healthcare professional review any AI-driven decision to deny, delay, or modify medical care based on medical necessity. The bill prohibits using AI alone for such decisions without this human review, which must consider the patient’s medical history, the provider’s recommendation, and individual clinical circumstances. Violations would be treated as unfair claims practices, allowing affected patients to sue for actual damages, punitive damages, and attorney fees. The law would take effect on July 1, 2026, for most purposes.
SB 2040, the "FAIR Rx Act," prohibits pharmacy benefits managers (PBMs) from owning, controlling, or having any financial interest in pharmacies in Tennessee after January 1, 2027. It requires pharmacies to disclose all owners with 5% or more stake and prevents PBMs from using contracts (like management or revenue-sharing agreements) to exert operational control over pharmacies. The bill directly affects PBMs, pharmacies (especially rural and community ones), and aims to prevent conflicts of interest that could restrict patient choice, increase costs, or undermine pharmacist independence. By separating financial control from patient care decisions, it seeks to improve transparency and affordability in prescription drug access.
HJR 749 is a non-binding resolution recognizing Tennessee's youth substance abuse crisis, citing data from the 2022-2023 Tennessee Together Student Survey showing high rates of vaping (29.8% of students), underage alcohol use (33% of students), and prescription drug misuse. It recommends implementing a long-term, evidence-based prevention program in school curricula - from kindergarten through graduation - to teach life skills, mental health support, and healthy decision-making. The resolution does not create new laws but urges the Tennessee Department of Education to adopt this approach, emphasizing its cost-effectiveness (saving $4.60-$18.00 for every $1 spent). Introduced in January 2026, it was withdrawn in February 2026 without further legislative action.
SB 2081 expands a Tennessee law that prohibits health insurance plans from requiring step therapy (trying less expensive treatments first) before covering approved cancer drugs. It removes the current restriction that only applied to "stage 4 advanced metastatic cancer or metastatic blood cancer," instead applying the prohibition to **all cancer diagnoses**. This means cancer patients in Tennessee with insurance plans covering cancer treatment cannot be forced through step therapy protocols before accessing approved drugs. The law takes effect January 1, 2027, for new or renewed insurance policies.
SB 1796 requires Tennessee's Commissioner of Commerce and Insurance to publish a report by October 1, 2026, detailing alleged violations of pharmacy reimbursement laws (specifically §56-7-3124) by pharmacy benefits managers (PBMs) during the prior fiscal year. The report must include the total number of reported violations, the commissioner's investigation findings, and any penalties imposed for violations. This bill directly affects PBMs (who manage prescription drug benefits for insurers) and pharmacies that may face delayed reimbursements, by mandating transparency in enforcement actions without creating new penalties or requirements.
SB 420 prohibits insurers, pharmacy benefits managers, and third-party administrators in Tennessee from altering health plan coverage terms - such as cost-sharing or benefit design - based on whether a patient has access to prescription drug assistance programs (like manufacturer coupons or patient aid). This directly affects health plan enrollees who use such programs to lower drug costs. The bill requires insurers to calculate cost-sharing contributions based on actual patient payments, not external assistance, and applies to plans entered into or renewed on or after January 1, 2026. It aims to prevent insurers from penalizing patients for utilizing available drug cost-saving resources.
SB 881 removes limits on penalties for pharmacy benefits managers (PBMs) that fail to pay pharmacies promptly under Tennessee law. It requires PBMs to pay "clean claims" (complete, error-free claims) within 30 days for paper submissions and 14 days for electronic submissions, with interest accruing for late payments. The bill establishes tiered penalties: failing to pay 95% of clean claims triggers up to $10,000 in fines, 85% triggers $10,000-$100,000, and 60% triggers $100,000-$200,000. This directly affects PBMs (like those managing prescription drug benefits) and pharmacies that rely on timely payments from them.
