Tennessee Legislature (healthcare bills) · April 28, 2025 · Primary source
TN SB 436: Drugs, Prescription - As enacted, adds mandating the use of biosimilar drugs as a cost-saving measure the bureau of TennCare may implement; adds that a health carrier, health benefit plan, or utilization review organization may require a patient to try a biosimilar product prior to providing coverage for the equivalent branded prescription drug; requires the TennCare pharmacy advisory committee to consider as a factor the use of biosimilar drugs in the committee's recommendation to th
Summary
Tennessee enacted SB 436 (Public Chapter 206), which authorizes TennCare to mandate the use of biosimilar drugs as a cost-saving measure and permits health carriers, health benefit plans, and utilization review organizations to require patients to try a biosimilar product before covering the equivalent branded prescription drug. The law also directs the TennCare pharmacy advisory committee to factor biosimilar drug use into its recommendations. These changes apply to the TennCare Medicaid program and Tennessee-regulated health benefit plans.
What this may mean
Tennessee Medicaid and state-regulated health plans may now require biosimilar step therapy before authorizing coverage of branded biologics, creating new prior authorization and formulary design authority. Drug manufacturers, specialty pharmacies, and providers prescribing biologics under TennCare and Tennessee-regulated commercial plans face a strengthened biosimilar-first coverage framework.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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