[{"_1":2,"_124":-5,"_125":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100,112],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6109011,"mediaKeyId","2765031-a348bb20e8dd4e85651da493f7afce35","parentId",2765031,"title","Committee advances bill to ban programs that divert patient assistance from deductibles","audioSeconds",1559,"startMs",766000,"endMs",2325000,"viewUrl","/Search/View?dp=1&key=2765031-a348bb20e8dd4e85651da493f7afce35&start=766&end=2325","thumbnailUrl","https://assets.pipeline.soar.com/2765031-a348bb20e8dd4e85651da493f7afce35/thumbnail_766000.jpg","articleUrl","/articles/6109011/Tennessee/Committee-advances-bill-to-ban-programs-that-divert-patient-assistance-from-deductibles","mediaUrl","https://secure.pipeline.soar.com/6109011-2f04b9eb8386306e75d6f0784228ad40/orig.mp4?Expires=1770833287&Signature=ANKMwqmQ3PpuUZJGsvR010ULdswA4Tw2-rrdD5sNgF1eoe78NMPXtLvxN3MLZUwQtbgDKRT2PF3KxoAkhxfWfVl35~BAhUT8PLYe6IeUNMwaJ21NKfEoiP~dWjwB-9kSnhjOyi1S~WktEArDorK41gAwNNj85ngrN4z8lw2O3PCBcpYEhP2NvYAyQbgwUNQyA0wdJzeOQ5aXO3mGg1Re7Rw0hYOzoKfuPl3Vi3aUu~yfEQMqXK~bTPTneQSNEmbOqB6Oc4HVSWeOVVzmoFyLC11wtPYXRBvK~9VH1T~ejc0IJ0nVh~i-6ZVvycVvo6Zt4Bj94de2vGHt~ZnW7uJsXg__&Key-Pair-Id=KUT5TJCACFTXG","author","TN State Legislature","date","2025-03-25T00:00:00Z","article","The Tennessee House Insurance Committee advanced House Bill 870 on a unanimous voice vote after extended testimony and legal explanation on how so‑called alternative funding programs (AFPs) affect patients’ access to specialty drugs.

HB 870, sponsored in committee by Representative Lehi Rudder, would prohibit entities from using programs — described in testimony as “maximizers,” “optimizers,” “accumulators” or AFPs — in any way that prevents manufacturer patient assistance funds from counting toward a patient’s deductible or out‑of‑pocket maximums. An Office of Legal Services attorney told the committee the bill also includes a provision intended to avoid making certain health savings account (HSA)‑qualified plans ineligible under federal Internal Revenue Code section 223.

The bill’s sponsor told the committee the measure is intended to close recurring legal and programmatic workarounds that deny patients credit for assistance that should reduce their cost‑sharing obligations. “No entity should be permitted to engage in any activity which permits, prohibits, or restricts patients’ assistant funds from being applied to the patients’ deductible and out of pocket expenses,” Representative Lehi Rudder said.

Two witnesses described harms they attribute to AFPs. Patrick Nichols, a specialty pharmacist from Nashville, told the committee his health system documented more than 100 patients enrolled in AFPs in 2024 and cited delays and disruptions: “The average time it takes for a patient enrolled in an AFP to get medication from the time their doctor decides to treat them is almost 2 months … 20 percent of our patients enrolled in AFPs experienced a gap in therapy,” Nichols said. He said 36 percent of those patients were directed to international pharmacies and 30 percent to manufacturers’ patient assistance programs, which he said were designed for uninsured patients.

Brian Duvall, a Vanderbilt University Master of Public Health student who lives with severe hemophilia A, urged a ban on AFPs. “AFP must be banned and HB 870 is a step in the right direction for my community,” Duvall told lawmakers, arguing AFPs shift people with employer coverage into charity or foreign‑sourced supplies and create long waits for critical medicines.

Levin Middleton of the Office of Legal Services offered a technical explanation of the bill’s HSA language, saying the new text narrows the prior calculation requirement so it will not render HSA‑qualified plans ineligible under IRC section 223. Middleton explained the existing statute requires including all amounts paid on behalf of an enrollee when calculating out‑of‑pocket contributions, and the new language limits that requirement for HSA‑qualified high‑deductible plans until the plan deductible’s minimum is satisfied, except for preventive services.

After discussion and questions from members, the committee voted to advance HB 870 to the calendar and rules committee. The clerk announced the tally as 17 ayes, 0 nays.

Supporters said the bill protects patients from delayed care and preserves manufacturer assistance for those lacking other coverage; opponents were not recorded in committee testimony. The bill now moves to the next stage of the legislative process.","mediaType","Video","parentTitle","Insurance Committee\tMar 25, 2025","oneSentenceSummary","The Tennessee House Insurance Committee advanced House Bill 870 on a unanimous voice vote after extended testimony and legal explanation on how so‑called alternative funding programs (AFPs) affect patients’ access to specialty drugs.","taxTitle","Insurance, House of Representatives, Committees, Legislative, Tennessee","taxId",35385,"location","Tennessee","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6108993,"Votes at a glance: Insurance Committee advances hospital and nursing‑home assessments, PACE expansion",1751,576000,2327000,"/Search/View?dp=1&key=2765031-a348bb20e8dd4e85651da493f7afce35&start=576&end=2327","https://assets.pipeline.soar.com/2765031-a348bb20e8dd4e85651da493f7afce35/thumbnail_576000.jpg","/articles/6108993/Tennessee/Votes-at-a-glance-Insurance-Committee-advances-hospital-and-nursinghome-assessments-PACE-expansion","https://secure.pipeline.soar.com/6108993-d5186f7bc4f9b18f5f40eaa2aacef591/orig.mp4?Expires=1770833287&Signature=ZnyLrCMRfGNWMmgmd2hgiYHT5vONWKpG6CSoI7v5Thvw1sZdBVA2d9XD~8WCbI3odgXUOPqb99V0KJEPJNquATliLzInbAWFh20xPvWPXUW4L9JnWMHFVFjorF6Scwo-0YnqA8HtSPeoRRa56I3MkwI3YO7cHWUif9nwzTRJs7Ku-mW3iDQQXSWCxTSwqe67tHgH12omh~Z2jVqpJa1tTY0QdUk0siZUzcHwWNu-XIAoOV3yfsE0QCkHJP1cnywAypyexufVHwY8rWsnEUWiVfCmrc8LWON34jShSPMu5T7jh2uJM0cVWcauzwntczt-XmXzSo6HsoPtd7KQfljKcg__&Key-Pair-Id=KUT5TJCACFTXG","The Tennessee House Insurance Committee advanced several bills with little debate during the same hearing session.

- House Bill 829 (annual hospital assessment): Committee attached an amendment (4503) then voted to advance the bill to the Finance, Ways and Means Committee. The clerk recorded 13 ayes and 0 nays during the roll call recorded in committee.

- House Bill 728 (annual nursing home assessment): Representative(s) explained the bill extends the annual nursing‑home assessment for FY 2025–26. The clerk recorded 14 ayes and 0 nays and the bill moved to Finance, Ways and Means.

- House Bill 782 (PACE expansion): Representative Martin said the bill requires TennCare to authorize an additional PACE program in West or Middle Tennessee and expands the Chattanooga program’s service area. The clerk recorded 17 ayes and 0 nays; HB 782 was advanced to Government Operations.

Each of these measures passed committee by recorded voice or roll calls with unanimous support and will proceed to the next committee or calendar for further action.","The House Insurance Committee advanced several routine and policy bills by unanimous voice votes: annual hospital and nursing‑home assessments, and a bill to add or expand PACE programs; clerks recorded unanimous tallies for each item and the bills moved to the next committee or calendar.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6108998,"Committee approves two‑year remote monitoring pilot for maternal hypertension and diabetes",199,2683000,2882000,"/Search/View?dp=1&key=2765031-a348bb20e8dd4e85651da493f7afce35&start=2683&end=2882","https://assets.pipeline.soar.com/2765031-a348bb20e8dd4e85651da493f7afce35/thumbnail_2683000.jpg","/articles/6108998/Tennessee/Committee-approves-twoyear-remote-monitoring-pilot-for-maternal-hypertension-and-diabetes","https://secure.pipeline.soar.com/6108998-f448ff988f25d89fdfc724595a35fe03/orig.mp4?Expires=1770833287&Signature=lRvx8PSZLHOsOAxogvPhESwwsqzMAOtFLfGLs~zYblYF2e~2VP~uOrTLHslS9TrU8FNdrze9o7I9ibPk5Qm~8wZ5z2w1mOEj-g~Y~hLhygzXcjvwcwdOSHY4k35NSzy6-KRUo5Afh4Jm6UDY8~s1eA1OvvtIeHCAeukB4A3mgc5szhc0tSLcoBY9pAEcGdYUnud58nFKGJu1L~2NzGoekceuPhchwWG3zUeUmSxHhjPh-BHQiQr~jxUMDamvlZ3gtTqoj7VEYbiy-ATXeQ32l0-NKqtqGakJYwJF8UH9uPi1GgJp1e5LZ7oXc9ji6n-3F51Kw5lqar1Bgqfk3GnCdg__&Key-Pair-Id=KUT5TJCACFTXG","The Insurance Committee unanimously advanced House Bill 867, which establishes a TennCare‑administered pilot program for remote patient monitoring (RPM) of maternal hypertension and diabetes.

Representative Jim Hicks explained the amendment attached to HB 867 limits enrollment to no more than 300 pregnant or postpartum women, caps the program cost at $600,000, and sets the pilot to conclude two years after implementation. The sponsor said TennCare will administer the pilot and aim to deploy it statewide, with priority for rural counties.

Sponsor remarks described RPM as a tool to improve outcomes and access while lowering overall health care costs by enabling clinicians to monitor patients remotely and catch problems earlier. Committee members asked how participants would be selected and whether urban populations would also be included; the sponsor said the program would be available across the state and would especially target rural areas.

The committee voted to forward HB 867 to the Government Operations Committee; the clerk recorded 18 ayes and 0 nays.","House Bill 867 would create a TennCare‑administered remote patient monitoring pilot covering up to 300 pregnant and postpartum women with hypertension or diabetes, capped at $600,000 and running two years; the Insurance Committee voted unanimously to advance the pilot.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6109004,"Committee bars step‑therapy for metastatic cancer patients, citing delays that cost lives",210,2418000,2628000,"/Search/View?dp=1&key=2765031-a348bb20e8dd4e85651da493f7afce35&start=2418&end=2628","https://assets.pipeline.soar.com/2765031-a348bb20e8dd4e85651da493f7afce35/thumbnail_2418000.jpg","/articles/6109004/Tennessee/Committee-bars-steptherapy-for-metastatic-cancer-patients-citing-delays-that-cost-lives","https://secure.pipeline.soar.com/6109004-3926adb8a10d1692407d6b3643b5abdd/orig.mp4?Expires=1770833287&Signature=m-5tUI0bg~SKgxRUTEV-eTBgLwsFRamHj2mPQBeeJJEaRFZUtyhQ6rI61ft6IbzHjZJO39Qt94rpMKu8Vk26EMJH0VRzW~Hk-8dUMS4fjBNUbBcvvDQapF6DN59Sk~dql6wUBL0fRTB1ZOgFHLxxYRkWfpcic0lZBBe6mKLobnp6NN0Owtg0NiA0IRWZ8w~ltxbE80MMIr1az8pqPEUGkr040Lx-5TnQNXBLDaG0IereU2Q3uaF~XiuJ7MIRKwIQ5L2I96jrM3oVR73jB~qtF2jL25C~RDpmVFEi6syfiS2vpwBGY6yaJCVkN0-HN0-IChxZpIfxg7DFlOWzNeZnTQ__&Key-Pair-Id=KUT5TJCACFTXG","The House Insurance Committee unanimously approved an amendment to House Bill 858 that would prohibit step‑therapy (commonly called “fail‑first”) requirements for patients with metastatic cancer.

Representative Alexander, who sponsored the amendment, framed step therapy as an insurer policy that forces patients to try alternative, insurer‑preferred drugs before covering the medication their prescriber determined was appropriate. “This process forces cancer patients to take medications that may be less effective or even harmful before they can access the treatment their provider has determined is best,” Alexander said. He said delays of days or weeks can be fatal for patients with metastatic disease and urged members to eliminate the requirement for that population.

Alexander and other members recounted cases in which patients waited up to 10 days for insurer approval; the sponsor said those delays can have “devastating consequences.” Committee members emphasized that TennCare and Medicare do not impose the same step‑therapy requirements in the sponsor’s account, and the amendment is targeted at commercial insurers.

The committee voted to advance HB 858; the clerk recorded 18 ayes and 0 nays. The bill now moves to calendar and rules for further consideration.","The Insurance Committee approved an amendment to HB 858 that prevents insurers from imposing step‑therapy (fail‑first) requirements on patients with metastatic cancer; committee members and the sponsor said delays of days or weeks can be devastating.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6109007,"Parents and advocates press committee to let Katie Beckett Part A use HRA‑style accounts; bill rolled for TennCare testimony",1554,3226000,4780000,"/Search/View?dp=1&key=2765031-a348bb20e8dd4e85651da493f7afce35&start=3226&end=4780","https://assets.pipeline.soar.com/2765031-a348bb20e8dd4e85651da493f7afce35/thumbnail_3226000.jpg","/articles/6109007/Tennessee/Parents-and-advocates-press-committee-to-let-Katie-Beckett-Part-A-use-HRAstyle-accounts-bill-rolled-for-TennCare-testimony","https://secure.pipeline.soar.com/6109007-3b12f0bbf42d143536c72bd983ea4c03/orig.mp4?Expires=1770833287&Signature=bhf0ygsc~sTfkfiu84Eo2Q6Yi3fPgv0iGKvxrHhVMWmg~ysViLMtZdU3tJVpnMRnwBppx-ZO8FVz6prG5tJU~FMBMTmWNrK6pZ4pPwalcKa~JRtFDcru3ytd36PxJEpXo7hc1V1ENO6FPTBPZL65ohI0yYn0bIDmhNAZ~3T7Jo2Xd3d25DZUPNBvo75xwTSKaKhqFrh8FkGpczSSjg06dYzyvpZmJPrCz68u3FNAkOWaS~uq~ugOuvwfnx3BCoRUl85HvnRDFyXYSvmyhWzmQ6KXmwpUM9CrLHOXl9uEUieaGLTg3opMI7grlQkktRAiFW5TysS2iZxtQrCW9uggNg__&Key-Pair-Id=KUT5TJCACFTXG","Representative Lillian Lynn told the Insurance Committee HB 1158 would require TennCare to take steps to offer a health reimbursement account (HRA) option for families enrolled in the state’s Katie Beckett Part A program so they can access home‑and‑community‑based services funds more easily.

Parents and disability advocates described barriers in the current design and asked lawmakers for an HRA option. Trevor Anima, a parent and full‑time caregiver, said the program has been “life changing” for his daughter but that bureaucratic “red tape” and vendor practices prevent families from using the full allotment: “We have not been able to use the full allotted funds every year … there’s too much bureaucratic red tape for us to be able to access those funds,” Anima said.

Jeff Strand, director of public policy for the Tennessee Disability Coalition, told the committee the fiscal note raises concerns about TennCare’s design and implementation of Part A. Strand said the general assembly authorized $25 million annually for the program and that TennCare set the HCBS allotment at $15,000 per child, but TennCare’s fiscal materials show enrolled families use an average of about $2,700 of that amount; Strand asked where the remainder is going.

Strand and Anima gave concrete examples they say demonstrate vendor upcharges and inefficient use of funds: Anima described a minor home modification for which raw materials were roughly $200 while a vendor quote exceeded $2,000, and he said families he tracks observe vendor markups “a minimum 40%” on approved purchases.

Committee members expressed concern and several asked for TennCare to testify. After discussion, the committee agreed without objection to roll HB 1158 for one week so TennCare can respond to implementation and fiscal questions.

HB 1158 remains under committee consideration pending follow‑up testimony from TennCare and stakeholder discussions.","Witnesses urged the committee to allow a health reimbursement account option for families in Katie Beckett Part A so allocated home‑and‑community funds are easier to spend; committee agreed to roll HB 1158 one week to allow TennCare to respond to vendor and implementation concerns.","actionData","errors"]

Article not found

Committee advances bill to ban programs that divert patient assistance from deductibles

Votes at a glance: Insurance Committee advances hospital and nursing‑home assessments, PACE expansion

Committee approves two‑year remote monitoring pilot for maternal hypertension and diabetes

Committee bars step‑therapy for metastatic cancer patients, citing delays that cost lives

Parents and advocates press committee to let Katie Beckett Part A use HRA‑style accounts; bill rolled for TennCare testimony