Tennessee Senate Bill SB2576

Tennessee 2025-2026 Regular Session

• Introduced: 2/2/26

Caption

AN ACT to amend Tennessee Code Annotated, Title 8, Chapter 27; Title 56, Chapter 7 and Title 71, Chapter 5, relative to pharmacy benefits managers.

Summary

SB2576 revises Tennessee’s pharmacy benefit manager (PBM) reimbursement rules for prescription drugs, devices, and pharmacy services. The bill requires PBMs to reimburse contracted pharmacies at no less than the greatest of: the pharmacy’s actual cost, 105% of NADAC, WAC if NADAC is unavailable, or the amount the PBM pays itself or an affiliate for the same item or service. It also expands and clarifies the pharmacy appeal process when reimbursement is too low, including deadlines for payment, claim-level detail requirements, and rules for applying successful appeal findings to remaining refills on the prescription. The bill further prohibits PBMs from including professional dispensing fees in the reimbursement calculation, and it requires PBMs to pay a dispensing fee at least equal to the amount paid by TennCare when a pharmacy dispenses under a PBM or covered-entity agreement. That fee may not be shifted to patients through copays, deductibles, or other out-of-pocket charges. The act takes effect July 1, 2026, and applies to policies, plans, and contracts entered into, renewed, amended, or modified on or after that date.

Impact

SB2576 would amend Tennessee Code Annotated provisions governing PBM reimbursement and pharmacy appeals, strengthening minimum reimbursement standards and enforcement mechanisms. It creates or expands statutory obligations for PBMs and covered entities, including mandatory payment floors, faster appeal-related payments, claim-level disclosure, and double-damages-style penalties when reimbursement requirements are not met. The bill also affects pharmacies, pharmacy services administrative organizations, covered entities, and ultimately health plans and contracts subject to Tennessee law.

Sentiment

No committee transcripts or recorded votes were provided, so there is no direct evidence of debate or formal support/opposition in the supplied materials. Based on the bill text alone, the measure appears designed to favor pharmacies by increasing reimbursement protections and limiting PBM discretion, which typically aligns with concerns about underpayment and transparency in prescription drug pricing. The absence of recorded discussion means the overall sentiment cannot be measured from the provided context.

Contention

The main points of contention likely involve whether the bill would raise prescription drug costs for health plans and consumers, and whether the reimbursement floors and penalties are too restrictive for PBMs and covered entities. Pharmacies are likely to support the bill because it guarantees higher minimum reimbursement, faster appeals, and stronger remedies for underpayment. PBMs, insurers, and other covered entities may object to the mandated payment formulas, the double-payment penalties, the requirement to pay dispensing fees at TennCare levels, and the prohibition on passing those fees to patients.