Opioids

Plain English Breakdown

The official source material does not provide specific details on how insurers should treat non-opioid drugs compared to opioids beyond ensuring they are not disadvantaged.

Opioids and Non-Opioid Treatments in Tennessee

This law allows insurance companies to create a list of preferred drugs for pain treatment but requires them to treat non-opioid pain medications fairly compared to opioid medications.

What This Bill Does

• Allows insurers to make or change a list of preferred drugs (PDL) for group insurance plans covering state employees.
• Requires insurers to ensure that non-opioid pain medications approved by the FDA are not treated unfairly when compared to opioid medications on the PDL.
• Applies these rules to non-opioid drugs nine months after they are approved by the FDA, instead of immediately as originally planned.

Who It Names or Affects

• Insurance companies that offer group insurance plans to state employees in Tennessee.
• Healthcare providers who prescribe pain medications.
• Patients receiving treatment for pain under group insurance plans.

Terms To Know

Preferred Drug List (PDL)

A list of drugs that an insurer prefers to cover, often because they are considered more cost-effective or effective than other options.

Non-opioid treatment

Medications for pain relief that do not act on the body's opioid receptors and therefore have different effects from opioids.

Limits and Unknowns

• The law does not specify how insurers should treat non-opioid drugs compared to opioids, only that they cannot be disadvantaged.
• It is unclear what specific changes will occur in insurance plans due to the removal of reimbursement requirements for healthcare providers and hospitals.

Official Summary Text

This bill authorizes an insurer that offers group insurance plans ("insurer") to adopt or amend a state preferred drug list ("PDL
"). In establishing and maintaining the PDL, this bill requires the insurer to ensure that a non-opioid drug approved by the food and drug administration ("FDA") for the treatment or management of pain is not disadvantaged or discouraged with respect to
c
overage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL.

However, this bill does not prohibit an opioid medication from being preferred over other opioid medications, or a non-opioid medication from being prefer
red over other non-opioid medications. This bill applies to a non-opioid drug immediately upon its approval by the FDA for the treatment or management of pain, regardless of whether the drug has been reviewed by the insurer for inclusion on the PDL. Th
i
s bill also applies to drugs being provided under a contract between the insurer and a pharmacy benefits manager for purposes of a group insurance plan.

This bill requires an insurer to ensure that (i) reimbursement is provided to a healthcare prescribe
r who provides a non-opioid treatment to a covered employee under the group insurance plan, and (ii) to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed separately under the group i
n
surance plan for any non-opioid treatment provided as a part of those services.

ON MARCH 24, 2025, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 37, AS AMENDED.
'

AMENDMENT #1 makes the following revisions:



Revises the provision that applies the bill
to a non-opioid drug immediately upon its approval by the
FDA
for the treatment or management of pain
to, instead apply the bill to
a non-opioid drug after it has been approved by
the FDA
for a period of nine months or longer
for such treatment or management.



Removes the provision requiring a
n insurer, for purposes of offering a group insurance plan,
to
ensure that reimbursement is provided to a healthcare prescriber who provides a non-opioid treatment to a covered employee under the group insurance plan.



Removes the provision requiring an
insurer
to
ensure that, to the extent permitted by law, a hospital that provides either inpatient or outpatient services to a recipient is reimbursed separately under the group insurance plan for any non-opioid treatment provided as a part of those services.



Changes the effective date from July 1, 2025, to January 1, 2026.

Current Bill Text

HOUSE BILL 37
By Davis

SENATE BILL 428
By Reeves

SB0428
000599
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 8;
Title 53; Title 56; Title 63; Title 68 and Title 71,
relative to the use of drugs for the treatment of
pain.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, is amended by adding
the following new part:
56-7-3801.
As used in this part:
(1) "Group insurance plan" means a group insurance plan that covers
state employees approved pursuant to title 8, chapter 27;
(2) "Healthcare prescriber" means a prescriber as defined in § 53-10-
203;
(3) "Insurer" means an insurer that offers a group insurance plan; and
(4) "Non-opioid treatment" means a drug or biological product that is
indicated to produce analgesia without acting on the body's opioid receptors.
56-7-3802.
(a) Except as otherwise provided in this section, an insurer, for purposes of
offering a group insurance plan, may adopt or amend a state preferred drug list (PDL).
(b)
(1) In establishing and maintaining the PDL, the insurer shall ensure that
a non-opioid drug approved by the United States food and drug administration for
the treatment or management of pain is not disadvantaged or discouraged with

- 2 - 000599

respect to coverage relative to an opioid or narcotic drug for the treatment or
management of pain on the PDL.
(2) Subdivision (b)(1) does not prohibit an opioid medication from being
preferred over other opioid medications, or a non-opioid medication from being
preferred over other non-opioid medications.
(c) This section applies to a non-opioid drug immediately upon its approval by
the United States food and drug administration for the treatment or management of pain,
regardless of whether the drug has been reviewed by the insurer for inclusion on the
PDL. This section also applies to drugs being provided under a contract between the
insurer and a pharmacy benefits manager for purposes of a group insurance plan.
56-7-3803.
(a) An insurer, for purposes of offering a group insurance plan, shall ensure that
reimbursement is provided to a healthcare prescriber who provides a non-opioid
treatment to a covered employee under the group insurance plan.
(b) The insurer shall ensure that, to the extent permitted by law, a hospital that
provides either inpatient or outpatient services to a recipient is reimbursed separately
under the group insurance plan for any non-opioid treatment provided as a part of those
services.
SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.