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HB 1198

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 the bureau of TennCare on any drugs to be added to the state preferred drug list. - Amends TCA Title 4; Title 53; Title 56; Title 68 and Title 71.

114th Regular Session (2025-2026) Introduced by Doc Kumar

Tennessee allows TennCare and insurers to require patients to use cheaper biosimilar drugs before covering brand-name biologics, aiming to reduce prescription costs.

Pub. Ch. 206
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Bill Summary · HB 1198

Legislative bill overview

HB 1198 authorizes Tennessee's TennCare program and health insurers to require patients to use biosimilar drugs (lower-cost alternatives to brand-name biologics) before covering the more expensive original medications. It also mandates that the state's pharmacy advisory committee consider biosimilar usage when determining which drugs to add to the preferred drug list.

Why is this important

Biosimilars typically cost 15-35% less than brand-name biologics and are used to treat serious conditions like cancer, autoimmune diseases, and diabetes. This policy aims to reduce prescription drug costs for the state budget and insurers, potentially lowering out-of-pocket costs for patients—but may also affect treatment flexibility and access timelines for specific patient populations.

Potential points of contention

  • Medical necessity concerns: Patients whose physicians determine a specific branded biologic is medically necessary for their condition may face mandatory switches to biosimilars first, potentially delaying optimal treatment
  • Insurance company incentives: Health carriers gain authority to implement cost-saving requirements without explicit clinical criteria, raising concerns about profit-driven rather than evidence-based drug selection
  • Biosimilar interchangeability questions: Not all biosimilars are deemed "interchangeable" by the FDA; the bill doesn't clearly distinguish between interchangeable and non-interchangeable biosimilars, which have different clinical implications

Compiled from official sources — confirm details with the bill’s official record.

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