Bill > HB0870

This bill aims to regulate how insurers, pharmacy benefits managers (PBMs), and third-party administrators handle prescription drug costs and health plan coverage in Tennessee. The bill first defines key terms like "health plan" and "healthcare service" to clarify the scope of the legislation. It then establishes new rules for calculating an enrollee's cost-sharing contributions, requiring insurers to include all cost-sharing amounts paid by or on behalf of the enrollee, with specific provisions for health savings account-qualified high deductible health plans. The bill prohibits insurers, PBMs, and third-party administrators from changing or conditioning health plan coverage based on the availability of financial assistance for a prescription drug, which could help protect patients from potential pricing manipulations. There are some exceptions for generic drug alternatives, and the bill ensures compliance with federal limitations on annual cost-sharing. The legislation will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026, giving stakeholders time to adapt to the new requirements. The overall intent appears to be increasing transparency and protecting patients from potentially unfair practices in healthcare pricing and insurance coverage.

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https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB0870&ga=114