Bill > HB0858

This bill amends Tennessee's health insurance regulations to provide special protections for patients with stage 4 advanced metastatic cancer and metastatic blood cancer. The legislation defines "associated conditions" as symptoms or side effects related to these serious cancers and clarifies what constitutes stage 4 advanced metastatic cancer. Under the new provisions, health benefit plans must provide coverage for approved prescription drugs for these patients without requiring step therapy protocols, which are typically insurance requirements that mandate patients try less expensive treatments before approving more specialized medications. The bill specifies that an "approved prescription drug" must be FDA-approved, consistent with best medical practices, supported by peer-reviewed literature, and on the health plan's formulary. Healthcare providers must submit annual reports to the health department detailing the number of cases treated, specific drugs used, and six-month survival rates. The bill allows an exception for group insurance plans offered under a specific state title and permits insurers to require patients to try generic equivalents before covering branded drugs. The new regulations will take effect on January 1, 2026, and apply to insurance policies entered into, renewed, or amended after that date, potentially providing more treatment flexibility for patients with advanced cancer.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0858&ga=114