Tennessee 2025-2026 Regular Session

Tennessee Senate Bill SB0420 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2		-	HOUSE BILL 870
3		-	By Rudder
	2	+	<BillNo> <Sponsor>
4	3
5	4		SENATE BILL 420
6	5		By Reeves
7	6
8	7
9	8		SB0420
10	9		001736
11	10		- 1 -
12	11
13	12		AN ACT to amend Tennessee Code Annotated, Title 4;
14	13		Title 8; Title 10; Title 53; Title 56; Title 63; Title 68
15	14		and Title 71, relative to pharmacy benefits.
16	15
17	16		BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
18	17		SECTION 1. Tennessee Code Annotated, Section 56-7-3201, is amended by adding
19	18		the following new subdivisions:
20	19		( ) ''Health plan'' means a policy, contract, certification, or agreement offered or
21	20		issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the
22	21		costs of healthcare services;
23	22		( ) ''Healthcare service'' means an item or service furnished to an individual for
24	23		the purpose of preventing, diagnosing, alleviating, curing, or healing human illness,
25	24		injury, or physical disability;
26	25		( ) ''Insurer'' means an entity subject to the insurance laws and rules of
27	26		insurance in this state or subject to the jurisdiction of the commissioner, that contracts or
28	27		offers to contract to provide, deliver, arrange for, pay for, or reimburse the costs of
29	28		healthcare services under a health plan in this state;
30	29		( ) ''Third-party administrator'' means a third-party administrator as defined in §
31	30		56-7-2902.
32	31		SECTION 2. Tennessee Code Annotated, Section 56-7-3205, is amended by deleting
33	32		the section and substituting:
34	33		(a) When calculating an enrollee's contribution to an applicable cost sharing
35	34		requirement, an insurer shall include cost sharing amounts paid by the enrollee or on
36	35		behalf of the enrollee by another person. If, under federal law, application of this
37	36
38	37
39	38		- 2 - 001736
40	39
41	40		requirement would result in health savings account ineligibility under § 223 of the federal
42	41		internal revenue code (26 U.S.C. § 223), then this requirement applies for health savings
43	42		account-qualified high deductible health plans with respect to the deductible of such a
44	43		plan after the enrollee has satisfied the minimum deductible under § 223 of the federal
45	44		internal revenue code (26 U.S.C. § 223), except for items or services that are preventive
46	45		care pursuant to § 223(c)(2)(C) of the federal internal revenue code (26 U.S.C. §
47	46		223(c)(2)(C)), in which case the requirements of this subsection (a) apply regardless of
48	47		whether such minimum deductible has been satisfied.
49	48		(b) Subsection (a) does not apply to a prescription drug for which there is a
50	49		generic alternative, unless the enrollee has obtained access to the brand name
51	50		prescription drug through prior authorization, a step therapy protocol, the insurer's
52	51		exceptions and appeals process, or as specified in § 53-10-204(a).
53	52		(c) The annual limitation on cost sharing provided for under 42 U.S.C. §
54	53		18022(c)(1) applies to all healthcare services covered under a health plan offered or
55	54		issued by an insurer in this state.
56	55		(d) An insurer, pharmacy benefits manager, or third-party administrator shall not
57	56		directly or indirectly set, alter, implement, or condition the terms of health plan coverage,
58	57		including the benefit design, based in part or entirely on information about the availability
59	58		or amount of financial or product assistance available for a prescription drug.
60	59		(e) In implementing the requirements of this section, the state shall only regulate
61	60		an insurer, pharmacy benefits manager, or third-party administrator to the extent
62	61		permissible under applicable law.
63	62		SECTION 3. This act takes effect upon becoming a law, the public welfare requiring it,
64	63		and applies only to health plans entered into, amended, extended, or renewed on or after
65	64		January 1, 2026.