AN ACT to amend Tennessee Code Annotated, Title 8; Title 56; Title 63; Title 68 and Title 71, relative to step therapy.
Summary
This bill limits the use of step therapy protocols for certain cancer patients in Tennessee. Specifically, for enrollees diagnosed with stage 4 advanced metastatic cancer or metastatic blood cancer, health benefit plans generally may not require a patient to fail first on other medications before covering an approved prescription drug. The bill also extends this protection to drugs used to treat associated conditions of those cancers, so long as the treating provider identifies the condition as related to the cancer or its treatment when seeking authorization.
The bill defines key terms such as “stage 4 advanced metastatic cancer,” “associated conditions,” and “approved prescription drug.” To qualify, the drug must be FDA-approved, consistent with best practices, supported by peer-reviewed evidence and the National Comprehensive Cancer Network Drugs and Biologics Compendium, and included on the plan’s formulary. The bill does not apply to state or local insurance programs under Title 8, Chapter 27, and it preserves a plan’s ability to require use of AB-rated generic equivalents, interchangeable biologics, or biosimilars before covering a branded drug.
Impact
The bill amends Tennessee Code Annotated Title 56 governing insurance and health benefit plans, with related changes to Title 8 references for state and local insurance programs. It creates a statutory exception to step therapy requirements for certain advanced cancer patients and associated conditions, while preserving generic and biosimilar substitution rules. It also authorizes the commissioners of commerce and insurance and health to adopt implementing rules, and applies prospectively to policies or agreements entered into, renewed, or amended on or after January 1, 2026.
Sentiment
The available voting history suggests strong support for the measure, with the Senate Commerce and Labor Committee recommending passage by a unanimous 9-0 vote. The bill’s final enactment indicates it moved through both chambers successfully and was signed into law. No committee transcript is available, but the structure of the bill and the vote history suggest the proposal was viewed as a targeted patient-access measure rather than a broad insurance overhaul.
Contention
The main policy tension is between improving rapid access to cancer medications and preserving utilization management tools used by insurers to control costs and encourage lower-cost treatment options. The bill resolves that tension by carving out a narrow exception for advanced metastatic cancer and related conditions, while still allowing plans to require AB-rated generics, interchangeable biologics, or biosimilars. Another possible point of concern is the annual reporting requirement for treating providers, which may be seen as an administrative burden, though no recorded opposition appears in the provided materials.
AN ACT to amend Tennessee Code Annotated, Title 4; Title 8; Title 10; Title 53; Title 56; Title 63; Title 68 and Title 71, relative to pharmacy benefits.
AN ACT to amend Tennessee Code Annotated, Title 4; Title 8; Title 10; Title 53; Title 56; Title 63; Title 68 and Title 71, relative to pharmacy benefits.
AN ACT to amend Tennessee Code Annotated, Title 4; Title 8; Title 33; Title 36; Title 37; Title 48; Title 49; Title 52; Title 53; Title 55; Title 56; Title 62; Title 63 and Title 68, relative to health.