SB 907 would exempt certain high-cost prescription drugs from Tennessee's business tax on sales receipts. The bill specifically targets prescription medicines where the 30-day supply cost exceeds the Medicare Part D specialty tier threshold for 2025, as determined by the federal Centers for Medicare and Medicaid Services. It also extends the tax exemption to services related to preparing, storing, handling, administering, educating patients about, and monitoring these exempted drugs. This change would apply to pharmacies and other entities selling these medications starting July 1, 2025.
SB 2577 prohibits Tennessee state departments, agencies, and entities from contracting with pharmacy benefits managers (PBMs) that have been disciplined by the Department of Finance and Administration or the Department of Commerce and Insurance. The bill amends Tennessee law to apply this restriction to TennCare (Section 1), state committees (Section 2), and all state departments/agencies (Section 3). It takes effect July 1, 2026, applying to new, amended, or renewed contracts after that date. This directly affects state health programs and agencies that work with PBMs, requiring them to avoid vendors with prior disciplinary actions.
HB 2333 restricts pharmacy benefits managers (PBMs) in Tennessee by prohibiting them from modifying, restricting, or denying medications ordered by healthcare prescribers without proper process. It requires PBMs to respond to formulary exception or prior authorization requests within 24 hours for urgent cases or 72 hours otherwise, with requests deemed approved if unanswered. The bill also bans PBMs from retaliating against pharmacies or prescribers for exercising rights under the law and mandates annual reporting of response times and approval rates to state departments. This directly affects prescribers, pharmacies, and PBMs by protecting clinical decision-making and increasing transparency in medication access.
HB 2331 bars Tennessee state departments, agencies, or entities from contracting with pharmacy benefits managers (PBMs) that have been disciplined by the Department of Finance and Administration or Department of Commerce and Insurance. The bill directly affects PBMs facing disciplinary actions and state agencies seeking to hire them. Key provisions amend multiple Tennessee codes to require this prohibition for all state contracts, renewals, or amendments entered after July 1, 2026. This policy change aims to prevent state entities from working with PBMs that have violated regulations. The law applies broadly to all state agencies, not just Medicaid programs.
SB 2574 prohibits pharmacy benefits managers (PBMs) from altering, restricting, or denying medications ordered by healthcare prescribers without proper process. It requires PBMs to respond to special approval requests within 24 hours for urgent cases or 72 hours for others, with requests deemed approved if unresolved. The bill also bans PBMs from retaliating against pharmacies or prescribers for exercising their rights under the law and mandates annual reporting on approval rates, response times, and rebate arrangements to state departments. These provisions directly affect prescribers, pharmacies, and PBMs by strengthening prescriber authority and increasing transparency in medication access.
This bill requires Tennessee pharmacy benefits managers (PBMs) to reimburse pharmacies for prescription drugs at the highest of four specified amounts: the pharmacy's actual cost, 105% of the national drug cost average, the wholesale drug price, or the rate paid to their own affiliates. Pharmacies can appeal underpayments to the Department of Commerce and Insurance, and PBMs must pay double the owed amount if they fail to comply with the reimbursement minimums. The law directly affects independent pharmacies and PBMs by establishing enforceable payment standards and penalties for noncompliance, while prohibiting PBMs from deducting dispensing fees from reimbursements.
HB 2457 requires TennCare-managed care organizations (MCOs) and pharmacy benefits managers (PBMs) to reimburse claims for long-acting injectable HIV drugs used for both treatment and prevention. These drugs must be administered in settings like pharmacies, clinics, or hospitals, directly affecting TennCare enrollees with HIV. The bill mandates that MCOs/PBMs cover these drugs under either pharmacy or medical benefits but prohibits double reimbursement - providers can only be paid once per service. The law takes effect July 1, 2026, ensuring consistent coverage for this specific HIV care option.
SB 2499 requires TennCare-managed care organizations (MCOs) and pharmacy benefits managers (PBMs) to reimburse claims for long-acting injectable HIV treatment and prevention drugs administered in pharmacies, clinics, or medical facilities. This directly affects TennCare enrollees needing these drugs, MCOs/PBMs contracted with TennCare, and healthcare providers administering the treatments. The bill mandates single reimbursement for each treatment - either as a pharmacy benefit or medical service, but not both - to prevent duplicate payments. It applies specifically to covered HIV drugs administered in approved settings, ensuring consistent coverage under TennCare.
HB 2332 requires pharmacy benefits managers (PBMs) to reimburse contracted pharmacies for prescription drugs or services at no less than the highest of four specified amounts: the pharmacy’s actual cost, 105% of the national average drug cost (NADAC), the wholesale acquisition cost (WAC), or the amount the PBM pays itself for the same item. This directly affects independent pharmacies that contract with PBMs, ensuring they receive fairer compensation for dispensing medications. The bill establishes an appeal process for pharmacies disputing low reimbursements and mandates that PBMs pay double the owed amount if they fail to meet the required rate, with adjustments required within 14 days of a successful appeal. It also prohibits PBMs from deducting dispensing fees from reimbursement calculations.
HB 1959, the "FAIR Rx Act," prohibits pharmacy benefits managers (PBMs) from owning, controlling, or having any financial interest in pharmacies after January 1, 2027. It directly affects PBMs and pharmacies by banning arrangements like management contracts, revenue-sharing, or exclusive agreements that transfer operational control to PBMs. The bill requires pharmacies to disclose owners with 5%+ stakes and restricts limited-use pharmacy licenses from being sold to PBMs. These provisions aim to prevent conflicts of interest that could limit patient choice, increase costs, or undermine pharmacist independence in medication care.
