Senate Bill 2574, also known as House Bill 2333, amends various sections of the Tennessee Code Annotated to regulate pharmacy benefits managers (PBMs) more stringently. The bill establishes that PBMs cannot modify, restrict, or deny medications prescribed by healthcare prescribers unless a formulary exception or prior authorization is requested by the prescriber. It emphasizes that only healthcare prescribers have the authority to issue, modify, or discontinue medications, and any health plan provisions granting PBMs conflicting authority are deemed void. Additionally, the bill mandates that PBMs must ensure affordable access pathways for medically necessary medications and outlines specific timeframes for responding to prior authorization requests.

The legislation also prohibits retaliatory actions by PBMs against pharmacies or healthcare prescribers who exercise their rights under this section, with certain actions presumed retaliatory if they occur within 180 days of protected activities. Furthermore, PBMs are required to disclose contract terms and rebate arrangements to the Department of Commerce and Insurance upon request and must report annual metrics related to prior authorization processes. Violations of this section are classified as unfair trade practices, subjecting PBMs to civil penalties and allowing affected parties to seek legal recourse. The bill takes effect upon becoming law for rule promulgation purposes, with full implementation set for July 1, 2026.

Statutes affected:
Introduced: 56-7-3122, 56-8-104