Environmental & Healthcare Legislative Watch50 States · D.C. · U.S. Congress
From official state and federal legislative records. Informational only, not legal advice.
With a committee
A small team of lawmakers (a committee) is reading it closely and deciding if it's a good idea.
Next: the committee votes on whether it moves to the full chamber.
In plain words
AI summaryWritten by AI from the bill text. Check the official text before relying on it.
Fiscal Summary OTHER FISCAL IMPACT If the pharmacy benefits managers for TennCare and the State Group Insurance Program are unable to perform utilization management activities on behalf of the state, there will be a significant increase in expenditures for additional drug claims and utilization. The extent of such increase is dependent on a number of unknown factors, including the scope of the rules promulgated to implement the legislation, and cannot be estimated with reasonable certainty. Bill Summary This bill prohibits a pharmacy benefits manager from engaging in any of the following conduct: Exercising authority to modify, restrict, or deny a medication ordered by an individual authorized by law to prescribe drugs ("healthcare prescriber") unless the healthcare prescriber has initiated a request for a formulary exception or prior authorization, which such a request must be granted or denied within 24 hours for an exigent or urgent clinical circumstance or within 72 hours for a non-urgent request. If a pharmacy benefits manager fails to respond within such time, then the request is deemed approved. Imposing requirements that delay or prevent a healthcare prescriber from prescribing or modifying a medication based solely on clinical judgment. Enforcing or requiring a policy that interferes with the prescribing authority of a healthcare prescriber. Requiring a healthcare prescriber to obtain prior approval or perform a utilization management activity that directly alters, delays, or denies a medication unless authorized by a patient's health plan. Exercising, implementing, or enforcing any authority restricted under this bill through delegation, incorporation by reference, or contractual authorization contained in a health plan, plan document, or benefit design, unless such authority is expressly permit
