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TN HB2457

TN HB2457
AN ACT to amend Tennessee Code Annotated, Title 4; Title 56 and Title 71, relative to the coverage of long-acting injectable drugs for the treatment or prevention of human immunodeficiency virus.


summary

Introduced
02/03/2026
In Committee
02/05/2026
Crossed Over
Passed
Dead

Introduced Session

114th General Assembly

Bill Summary

As introduced, requires a managed care organization or pharmacy benefits manager that is contracted with the bureau to reimburse a claim for a long-acting injectable drug intended for treatment and prevention of human immunodeficiency virus and administered in a pharmacy, physician's office, clinic, ambulatory surgical treatment center, or hospital. - Amends TCA Title 4; Title 56 and Title 71.

AI Summary

This bill requires managed care organizations (MCOs), which are private companies that contract with the state to manage healthcare services for TennCare enrollees, and pharmacy benefits managers (PBMs), which manage prescription drug benefits, to reimburse claims for long-acting injectable drugs used to treat or prevent human immunodeficiency virus (HIV). This coverage applies regardless of where the drug is administered, including pharmacies, doctor's offices, clinics, ambulatory surgical treatment centers, or hospitals. The bill also specifies that if an MCO or PBM covers such a drug as a medical benefit, they must also cover it as a pharmacy benefit, with the condition that providers are only reimbursed for each individual treatment, and a provider can only be reimbursed under either the pharmacy or medical benefit, not both. This legislation aims to ensure access to these important HIV treatments and prevention methods for TennCare beneficiaries.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (2)

Last Action

Placed on s/c cal Tenncare Subcommittee for 3/3/2026 (on 02/25/2026)

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