Senate Bill 2499 aims to enhance the coverage of long-acting injectable drugs for the treatment and prevention of human immunodeficiency virus (HIV) in Tennessee. The bill amends Tennessee Code Annotated, Section 71-5-107(a), by adding a new subdivision that specifies these drugs must be administered in various healthcare settings, including pharmacies, physician's offices, clinics, ambulatory surgical treatment centers, or hospitals. Additionally, a new section, 71-5-175, is introduced, which mandates that managed care organizations (MCOs) and pharmacy benefits managers (PBMs) must reimburse claims for these long-acting injectable drugs when they are provided in the specified settings.

Furthermore, the bill stipulates that if an MCO or PBM covers a claim for these drugs as a medical benefit, they must also cover it as a pharmacy benefit, with certain conditions. Specifically, providers can only be reimbursed for each individual treatment or service provided, and they may choose to be reimbursed under either the pharmacy benefit or the medical benefit, but not both for the same claim. This legislation is set to take effect on July 1, 2026, ensuring that TennCare enrollees have access to necessary HIV treatments.

Statutes affected:
Introduced: 71-5-107(a), 71-5-107