Senate Bill 2499, also known as House Bill 2457, amends Tennessee law to enhance the coverage of long-acting injectable drugs specifically for the treatment and prevention of human immunodeficiency virus (HIV). The bill introduces a new subdivision to Tennessee Code Annotated, Section 71-5-107(a), which mandates that long-acting injectable drugs administered in various healthcare settings, including pharmacies and hospitals, be covered. Additionally, a new section, 71-5-175, is added to outline the reimbursement requirements for managed care organizations (MCOs) and pharmacy benefits managers (PBMs) regarding these drugs.

Under the new provisions, MCOs and PBMs are required to reimburse claims for long-acting injectable drugs intended for HIV treatment and prevention, regardless of whether they are billed as a medical or pharmacy benefit. However, the bill stipulates that providers can only receive reimbursement for each treatment under one benefit type, either medical or pharmacy. This legislation is set to take effect on July 1, 2026, ensuring that individuals receiving care for HIV have improved access to necessary medications.

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