Bill > HB2333

This bill aims to regulate the actions of pharmacy benefits managers (PBMs), which are entities that manage the prescription drug portion of health insurance plans, by preventing them from interfering with a healthcare prescriber's medical decisions. Specifically, PBMs are prohibited from modifying, restricting, or denying a medication ordered by a doctor or other authorized prescriber unless the prescriber initiates a request for a formulary exception or prior authorization, which must then be approved or denied within strict timeframes (24 hours for urgent situations, 72 hours for non-urgent ones), otherwise the request is automatically approved. The bill also prevents PBMs from imposing requirements that delay or alter a prescriber's ability to prescribe or modify medications based solely on clinical judgment, and any contract provisions that grant PBMs authority conflicting with these protections are void. Furthermore, PBMs cannot take retaliatory actions, such as terminating contracts or reducing reimbursement, against pharmacies or prescribers for exercising their rights under this law, and they are required to disclose certain contract terms and report data on prior authorization response times and approval rates to state departments. Violations are considered unfair trade practices, subject to civil penalties, and harmed parties can pursue legal action, though the bill does not apply to plans governed by the federal Employee Retirement Income Security Act (ERISA).

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https://wapp.capitol.tn.gov/apps/Billinfo/Default?BillNumber=HB2333&ga=114