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TennesseeHB 0858114th General Assembly (2025-2026)HouseWALLET

AN ACT to amend Tennessee Code Annotated, Title 8; Title 56; Title 63; Title 68 and Title 71, relative to step therapy.

Sponsored By: Rebecca K Alexander (Republican)

Became Law

Commerce and Insurance, Dept. of

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 0 costs, 1 mixed.

No step therapy for metastatic cancer

Beginning January 1, 2026, health plans in Tennessee cannot require step therapy before covering an approved drug for stage 4 advanced metastatic cancer or metastatic blood cancer. If the drug treats a related symptom or side effect, the doctor must tell the plan that it is an associated condition. The law defines stage 4 metastatic cancer as cancer that has spread from the main site. It defines associated conditions as symptoms or side effects that your doctor says would harm you if not treated. These rules apply to plans entered into, renewed, or changed on or after January 1, 2026.

Limits and exceptions to cancer drug access

Beginning January 1, 2026, an approved drug must be FDA‑approved, follow best treatment practices, be backed by peer‑reviewed evidence consistent with the NCCN Compendium, and be on your plan’s drug list (formulary). Plans may still make you try an AB‑rated generic, an interchangeable biologic, or a biosimilar before paying for a brand‑name drug. State and local group insurance plans under Tennessee Title 8, Chapter 27 are not subject to the step‑therapy ban. These rules apply to plans entered into, renewed, or changed on or after January 1, 2026.

Sponsors & Cosponsors

Sponsor

  • Rebecca K Alexander

    Republican • House

Cosponsors

  • G.A. Hardaway

    Democrat • House

  • Esther Helton-Haynes

    Republican • House

  • Justin Jones

    Democrat • House

  • Mary Littleton

    Republican • House

  • Susan M. Lynn

    Republican • House

  • Bryan Terry

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 243 • No: 0

House vote • 4/21/2025

FLOOR VOTE: MESSAGE CALENDAR CONCUR IN SENATE AMENDMENT # 1 4/21/2025

Yes: 92 • No: 0

Senate vote • 4/16/2025

FLOOR VOTE: as Amended Third Consideration 4/16/2025

Yes: 33 • No: 0

House vote • 3/31/2025

FLOOR VOTE: REGULAR CALENDAR AS AMENDED PASSAGE ON THIRD CONSIDERATION 3/31/2025

Yes: 94 • No: 0

House vote • 3/31/2025

HOUSE CALENDAR & RULES COMMITTEE

Yes: 0 • No: 0

House vote • 3/25/2025

HOUSE INSURANCE COMMITTEE

Yes: 18 • No: 0

House vote • 3/19/2025

INSURANCE SUBCOMMITTEE

Yes: 6 • No: 0

Actions Timeline

  1. Pub. Ch. 505

    5/27/2025

  2. Effective date(s) 01/01/2026

    5/27/2025

  3. Signed by Governor.

    5/21/2025

  4. Transmitted to Governor for his action.

    5/9/2025House

  5. Signed by Senate Speaker

    5/8/2025Senate

  6. Signed by H. Speaker

    4/30/2025House

  7. Enrolled; ready for sig. of H. Speaker.

    4/23/2025House

  8. H. concurred in S. am. no. 1 Ayes 92, Nays 0 PNV 1 HB0858

    4/21/2025House

  9. Senate substituted House Bill for companion Senate Bill.

    4/16/2025Senate

  10. Senate adopted Amendment (Amendment 1 - SA0243)

    4/16/2025Senate

  11. Passed Senate as amended, Ayes 33, Nays 0

    4/16/2025Senate

  12. H. Placed on Message Calendar 4/17/2025

    4/16/2025House

  13. Received from House, Passed on First Consideration

    4/3/2025Senate

  14. Engrossed; ready for transmission to Sen.

    4/1/2025House

  15. H. adopted am. (Amendment 1 - HA0149)

    3/31/2025House

  16. Sponsor(s) Added.

    3/31/2025House

  17. Passed H., as am., Ayes 94, Nays 0, PNV 0

    3/31/2025House

  18. H. Placed on Regular Calendar for 3/31/2025

    3/27/2025House

  19. Placed on cal. Calendar & Rules Committee for 3/27/2025

    3/26/2025House

  20. Rec. for pass. if am., ref. to Calendar & Rules Committee

    3/25/2025House

  21. Rec for pass if am by s/c ref. to Insurance Committee

    3/19/2025House

  22. Placed on cal. Insurance Committee for 3/25/2025

    3/19/2025House

  23. Placed on s/c cal Insurance Subcommittee for 3/19/2025

    3/12/2025House

  24. Ref. to Insurance Committee

    3/11/2025House

  25. Assigned to s/c Insurance Subcommittee

    3/11/2025House

Bill Text

  • HA0149 (Substitute)

    3/31/2025

    PDF

  • Enrolled / Public Chapter

    PDF

  • Fiscal Note

    PDF

  • Introduced

    PDF

  • SA0243

    PDF

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