PROHIBITION ON DISADVANTAGING NON-OPIOID DRUGS
Present law authorizes the bureau of TennCare to, in its sole discretion, adopt or amend a state preferred drug list (PDL). The adoption or amendment of a PDL, and the recommendations of the TennCare pharmacy advisory committee to the bureau are not agency actions and do not require rulemaking.
This bill changes "bureau of TennCare" to "division of TennCare" ("division") and requires the division, in establishing and maintaining the PDL, to ensure that no non-opioid drug approved by the U.S. FDA for the treatment or management of pain is disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the PDL. Impermissible disadvantaging or discouragement includes the following:
(1) Designating a non-opioid drug as a non-preferred drug if any opioid or narcotic drug is designated as a preferred drug; or
(2) Establishing more restrictive or more extensive utilization controls, including prior authorization or step therapy requirements for a non-opioid drug that are more restrictive or more extensive than the least restrictive or extensive utilization controls applicable to an opioid or narcotic drug.
This bill clarifies that the prohibition against disadvantaging a non-opioid drug applies to a non-opioid drug immediately upon its approval by the FDA for the treatment or management of pain, regardless of whether the drug has been reviewed by the division for inclusion on the PDL. This also applies to drugs being provided under a contract between the division and any managed care organization.
REIMBURSEMENT FOR NON-OPIOID TREATMENT
This bill requires the division to ensure that reimbursement is provided to a healthcare provider who provides a non-opioid treatment to a recipient under the medical assistance program.
This bill also requires that, to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient be reimbursed separately under the medical assistance program for any non-opioid treatment provided as a part of those services.
For purposes of this bill, a "non-opioid treatment" means a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors.
COVERAGE OF NON-OPIOID TREATMENTS
When a licensed physician prescribes a non-opioid treatment for the treatment of acute or chronic pain, this bill prohibits a managed care organization or other health insurance issuer from denying coverage of the non-opioid prescription drug in favor of an opioid prescription drug.
EDUCATION REGARDING NON-OPIOID ALTERNATIVES FOR TREATMENT OF PAIN
This bill requires the department of health ("department") to develop and publish on its website, no later than September 30, 2024, an educational pamphlet regarding the use of non-opioid alternatives for the treatment of pain. The pamphlet must include (i) information on available non-opioid alternatives for the treatment of pain, including non-opioid medicinal drugs or drug products and non-pharmacological therapies; and (ii) the advantages and disadvantages of the use of non-opioid alternatives.
This bill requires the department to work with the Tennessee opioid abatement council to explore and utilize, to the extent permissible by state and federal law, opioid abatement funding for educational and healthcare services related to non-opioid alternatives.
INFORMING PATIENTS OF NON-OPIOID TREATMENTS
As of October 1, 2024, this bill requires a healthcare practitioner to do the following before prescribing, ordering, dispensing, or administering an opioid drug listed as a Schedule II controlled substance for the treatment of pain, except in cases of provision of emergency services and care before providing anesthesia:
(1) Inform the patient of available non-opioid alternatives for the treatment of pain, which may include non-opioid medicinal drugs or drug products, interventional procedures or treatments, acupuncture, chiropractic treatments, massage therapy, physical therapy, occupational therapy, or any other appropriate therapy as determined by the healthcare practitioner;
(2) Discuss the advantages and disadvantages of the use of non-opioid alternatives, including whether the patient is at a high risk of, or has a history of, controlled substance abuse or misuse and the patient's personal preferences; and
(3) Provide the patient with the educational pamphlet developed by the department and document the non-opioid alternatives considered in the patient's record.
ON MARCH 28, 2024, THE HOUSE ADOPTED AMENDMENTS #1 AND #2 AND PASSED HOUSE BILL 2903, AS AMENDED.
AMENDMENT #1 rewrites the bill to, instead, do the following:
(1) Authorize the division of TennCare ("division"), in its sole discretion, to adopt or amend a state preferred drug list (PDL). The adoption or amendment of a PDL, and the recommendations of the TennCare pharmacy advisory committee to the division, are not agency actions and do not require rulemaking;
(2) In establishing and maintaining the PDL, require the division to ensure that a non-opioid drug approved by the FDA for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to any opioid or narcotic drug for the treatment or management of pain on the PDL. However, this provision does not prohibit an opioid medication from being preferred over other opioid medications, or a non-opioid medication from being preferred over other non-opioid medications;
(3) Establish that the bill applies to a non-opioid drug immediately upon its approval by the FDA for the treatment or management of pain, regardless of whether the drug has been reviewed by the division for inclusion on the PDL. The bill also applies to drugs being provided under a contract between the division and any managed care organization;
(4) Define, for purposes of the bill, a "non-opioid treatment" as a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors;
(5) Require the division to ensure that reimbursement is provided to a healthcare provider who provides a non-opioid treatment to a recipient under the medical assistance program;
(6) Require the division to ensure that, to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed under the medical assistance program for any medically necessary non-opioid treatment provided as a part of those services; and
(7) When a licensed physician prescribes a non-opioid medication for the treatment of acute or chronic pain, prohibit a managed care organization or other health insurance issue from denying coverage of the non-opioid prescription drug in favor of an opioid prescription drug.
AMENDMENT #2 revises the bill to prohibit a managed care organization or other health insurance issuer from denying coverage of a non-opioid prescription drug in favor of an opioid prescription drug when a healthcare prescriber, instead of a licensed physician, prescribes a non-opioid medication for the treatment of acute or chronic pain.

Statutes affected:
Introduced: 71-5-199
Amended with HA0665, HA0664 -- 03/28/2024: 71-5-199