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SB 428

Opioids - As enacted, authorizes an insurer, for purposes of group insurance plans offered to state employees, to adopt or amend a state preferred drug list (PDL); requires the insurer to ensure that a non-opioid drug approved by the U.S. food and drug administration for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL. - Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71.

114th Regular Session (2025-2026)

Tennessee law now requires state employee health insurers to ensure non-opioid pain medications aren't disadvantaged compared to opioids on preferred drug lists.

Comp. became Pub. Ch. 278
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Bill Summary · SB 428

Legislative bill overview

SB 428 requires insurers managing state employee group health plans to maintain a preferred drug list (PDL) that does not disadvantage FDA-approved non-opioid pain medications compared to opioid alternatives. The bill essentially mandates that non-opioid pain treatments receive equal or preferential coverage status to encourage their use as first-line options.

Why is this important

This bill addresses the opioid crisis by using insurance coverage as a lever to shift prescribing patterns toward non-opioid pain management. For state employees, this could reduce opioid dependence, overdose risk, and long-term addiction while potentially lowering healthcare costs. The policy reflects a public health strategy adopted by many states to combat opioid-related mortality and disability.

Potential points of contention

  • Cost implications: Non-opioid alternatives (such as certain biologics or advanced therapies) may be more expensive than traditional opioids, potentially increasing insurance premiums or limiting coverage depth elsewhere
  • Clinical flexibility concerns: Restricting opioid access on PDLs could limit physician discretion for patients with genuine medical need for opioid pain management, particularly those with cancer or severe acute pain
  • Implementation complexity: Insurance companies must redesign PDLs and prior authorization systems, creating administrative burden and potential coverage disruptions during transition

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

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