PBMs / Prescription Drugs – The Patient Access Choice and Transparency Act was passed during the 2019 legislative session prioritizing patient-centered care by making certain reforms to how Pharmacy Benefit Managers (PBMs) operate in Tennessee. It helps ensure patients can use the pharmacies they choose and trust rather than being forced by their insurance companies to use specialty pharmacies that often don’t meet patients’ needs. This is particularly important for patients with chronic, complex or rare diseases.
PBMs are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers and others. They are owned by insurance companies and often own pharmacies as well. As a big industry in the U.S., the top three PBMs in America service 230 million patients.
This new law does five important things:
•Protects rural hospitals that utilize 340B programs across the state to provide lifesaving medication to some of our state’s most marginalized citizens;
•Prohibits PBMs from steering patients away from their community pharmacies to PBM-owned pharmacies which is particularly important to patients with chronic, complex and rare diseases like Multiple Sclerosis, cystic fibrosis, cancer, and ALS;
•Ensures that pharmacies are at least paid their acquisition cost for medications and instructs PBMs to establish a process for pharmacies to appeal their reimbursements from PBMs if it is below the cost;
Provides greater transparency to employers who want to gain a better understanding of how their pharmacy benefit expenses are being impacted by spread pricing and rebate retention which ultimately impacts their premiums; and
•Provides more transparency for patients in real time when they are in a physician’s office as to what medications cost and their formulary.
SAFE Act / Substance Abuse Recovery Homes — Legislation designed to improve the quality of care for Tennesseans battling substance abuse has passed. The new law encourages sober-living homes to be nationally accredited to ensure the home’s management abides by a strict code of ethics to provide a safe and healthy living environment for patients in recovery. It requires the Department of Mental Health and Substance Abuse Services (DMHSAS) to establish and maintain a list of approved recovery residence organizations on its website. Recovery homes that have not reached these standards must post signage on their property under the bill’s provisions, and could risk losing licensure or face penalties.
The legislation expands on the Stopping Addiction & Fostering Excellence (SAFE) Act of 2018 by promoting best practices and making sure patients who utilize recovery homes receive the highest quality of care to succeed in their sobriety.
Organ Transplants / Individuals with Disabilities — Legislation was approved which prohibits health care providers and other entities from discriminating against an individual with disabilities who needs an organ transplant. The measure calls for health care providers responsible for matching anatomical gifts and organ donations to make reasonable changes to their policies and practices to allow individuals with disabilities access to transplantation-related treatment. Furthermore, the new statute does not allow health insurance companies to restrict transplantation coverage for the sole reason of a person’s disability. Any individual who feels that an entity has violated the provisions of this law has standing to bring forth a civil suit against the entity.
COVID-19 Recovery / TN Business Fairness Act – A new law approved this year allows businesses to remain open during a pandemic or other health emergency if they follow guidelines issued by any government to keep their customers and employees safe. The Tennessee Business Fairness Act puts all businesses on the same playing field in a declared state of emergency, so small businesses are not forced to close while their bigger competitors stay open.