AN ACT to amend Tennessee Code Annotated, Title 8; Title 56; Title 63; Title 68 and Title 71, relative to step therapy.
Summary
HB1956 revises Tennessee’s step-therapy rules for health benefit plans in cases involving cancer. The bill broadens existing protections by replacing narrower references to “stage 4 advanced metastatic cancer” and “metastatic blood cancer” with the broader category of “cancer or the treatment of cancer.” As a result, a health plan that covers cancer and associated conditions may not require an enrollee diagnosed with cancer to first fail through a step-therapy protocol before receiving coverage for an approved prescription drug, subject to the bill’s stated exceptions.
The bill also removes several related statutory provisions tied to the prior narrower cancer categories and authorizes the commissioners of commerce and insurance and health to adopt rules to implement the act. It takes effect January 1, 2027, and applies to policies or agreements entered into, renewed, or amended on or after that date.
Impact
HB1956 amends Tennessee Code Annotated in Title 56, the insurance code, to expand step-therapy exemptions for cancer patients and align the law with a broader cancer-treatment standard. It affects health benefit plans, insurers, and enrollees by limiting when prior authorization or medication sequencing requirements can be imposed for approved cancer drugs. The bill also gives state regulators rulemaking authority to carry out the new requirements and applies prospectively to future policy renewals and amendments.
Sentiment
The bill appears to have broad support and little visible opposition. It advanced unanimously through the Insurance Subcommittee, House Insurance Committee, and House Government Operations Committee, then passed the House overwhelmingly on third consideration with only one no vote, and later passed the final floor vote 30-3. The voting pattern suggests the measure was generally viewed favorably as a patient-protection and cancer-care access bill.
Contention
The main policy issue is the balance between insurer utilization management and patient access to cancer treatment. Supporters appear to favor removing step-therapy barriers for anyone diagnosed with cancer, while any dissent likely centers on the cost and coverage-management implications for insurers and health plans. The bill’s expansion from advanced metastatic cancers to all cancers is the key substantive change and the most likely point of debate, though the committee record provided does not include detailed objections.
AN ACT to amend Tennessee Code Annotated, Title 4, Chapter 29; Title 8, Chapter 50; Title 33; Title 36; Title 52; Title 56; Title 63 and Title 68, relative to therapists.
AN ACT to amend Tennessee Code Annotated, Title 4, Chapter 29; Title 8, Chapter 50; Title 33; Title 36; Title 52; Title 56; Title 63 and Title 68, relative to therapists.