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HB 1956

Insurance Companies, Agents, Brokers, Policies - As introduced, expands the prohibition, from stage 4 advanced metastatic cancer or metastatic blood cancer to any cancer, against a health benefit plan that provides coverage for cancer requiring the use of a step therapy protocol before the health benefit plan provides coverage for an approved prescription drug to an enrollee who has received a diagnosis of cancer. - Amends TCA Title 8; Title 56; Title 63; Title 68 and Title 71.

114th Regular Session (2025-2026) Introduced by Becky Jo Alexander

Bill eliminates insurance step therapy requirements for all cancer diagnoses, expanding current limits on stage 4 cancers, accelerating drug access but potentially increasing premiums.

Senate substituted House Bill for companion Senate Bill.
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Bill Summary · HB 1956

Legislative bill overview

HB 1956 expands Tennessee's existing prohibition on step therapy protocols for cancer patients. Currently, the ban applies only to patients with stage 4 advanced metastatic cancer or metastatic blood cancer; this bill would extend the prohibition to patients with any cancer diagnosis. Step therapy requires patients to try lower-cost drugs first before insurance covers more expensive or specialized treatments.

Why is this important

Cancer patients often need immediate access to specific medications tailored to their cancer type and stage, and delays caused by step therapy protocols can have serious health consequences. This change could accelerate treatment access for earlier-stage cancer patients but would also increase insurance costs, which may be passed to consumers through higher premiums or reduced plan options.

Potential points of contention

  • Insurance cost impact: Eliminating step therapy requirements for all cancer patients removes a cost-containment tool, potentially raising premiums for all enrollees to cover faster access to expensive drugs
  • Medical appropriateness concerns: Some argue step therapy ensures patients receive evidence-based treatment first; broader restrictions may bypass clinical review processes that determine optimal medication sequencing
  • Scope creep risk: Expanding the prohibition from a narrow category (metastatic cancer) to "any cancer" includes early-stage cases where step therapy protocols might have clinical justification and cost-effectiveness

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

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