This year’s action in the General Assembly saw a number of important improvements made in healthcare. Healthcare is an important area and one that we strive to improve each session. I am a member of the Senate Health and Welfare Committee as well as a Family Practitioner, so staying involved in the discussions concerning healthcare and the medical field is very important to me. I attended a Chronic Pain Discussion on October 28th that was organized by Pfizer. The purpose of the meeting was to partner with state level organizations, further educate about chronic pain, and discuss the need for access to new treatments. I was happy to attend this discussion, along with other legislators, and I hope that we continue to have quality discussions regarding the need for innovative therapies for pain patients
MEWAs – Among several laws passed by the General Assembly in 2019 seeking to provide Tennesseans with better access to health insurance, is legislation encouraging the expansion of Multiple Employer Welfare Arrangement (MEWAs). A MEWA is a pool of two or more self-insured employers, in the same profession, who pool resources and contributions in order to provide their employees with healthcare benefits. These health insurance plans are a way for small Tennessee businesses to offer employee benefits outside of government-run health insurance by sharing risks and costs. The new law clarifies the means by which a MEWA is able to determine insurance rates. It authorizes MEWAs to use case characteristics, claim experience, health status, or duration of coverage since issuance in determining the initial or adjusted premium rates for such employers pooling their liabilities.
Association Health Plans – Similarly, legislation addressing fees distributed and given to association health plans which allow small businesses to partner together in order to provide their employees with insurance passed this year. It clarifies that making payments to a trade or professional association, which are tax exempt, does not qualify as unfair trade practice in the business of insurance.
Proton Therapy Access Act – Another new statute which seeks to provide greater access to care for employees of the State of Tennessee provides that those diagnosed with cancer can receive hypo fractionated proton therapy if the physician and patient believe that it would be more beneficial to their treatment plan. The measure requires the state insurance plan to cover proton therapy at the same rate that would be paid for traditional radiation therapy (IMRT), as long as certain conditions have been met.
Pharmacy Benefit Managers – A major bill was approved during the 111th General Assembly supporting healthcare consumers in Tennessee and the pharmacies that provide care to them. The legislation establishes certain rights for pharmacies regarding fair contracts with Pharmacy Benefit Managers (PBMs), including the protection of a pharmacist’s professional judgement when determining when to dispense a drug or another product to a patient.
PBMs are third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans, and government employee plans. While originally created to process prescription drug claims and create a pharmacy network, PBMs have significantly grown in their size and influence over the past few decades. Currently, only three PBMs control approximately 80 percent of the prescription drug marketplace, giving them influence over patient access to prescription drugs. The PBMs also utilize spread pricing and negotiation of rebates from pharmaceutical manufacturers to gain a stronghold over the prescription drug process, absent of any role in the development of prescription drugs or direct interaction with patients. The new law establishes a fair playing field between PBMs and pharmacies. Other provisions of the bill include protections for pharmacists regarding audits and recoupments of prescription claims. Additionally, it increases transparency and disclosure of all fees charged to pharmacies by PBMs at the time of claims processing and requires 30 days advance notification to the pharmacy of any network changes.
Healthcare Consumers / Truth in Advertising — Legislation was approved this year to address misleading and unclear “bad drug” and medical device compensation advertisements and the careless handling and selling of a person’s private health information. The new law prohibits advertisements which falsely lead viewers to believe a drug or device is no longer FDA approved through means such as using the phrases “medical alert,” “recall,” or “public service announcement,” or by displaying a government agency logo. It also calls for the advertisements to be more transparent by revealing who is sponsoring it, as well as adding a disclosure directing patients to “not stop taking a prescribed medication without first consulting their doctor.”
In addition, the legislation makes it illegal for third parties to collect, sell, or transfer a person’s protected health information without their knowledge. Penalties for violation of this statute are placed under the Tennessee Consumer Protection Act, punishable as a misdemeanor charge with up to one year in prison and/or a $1,000 fine.