TN HB2333

Pharmacy benefits managers (PBMs) are prohibited from modifying, restricting, or denying medications ordered by healthcare prescribers unless the prescriber initiates a formulary exception or prior authorization request

Prior authorization requests must be approved or denied within 24 hours for urgent cases and 72 hours for non-urgent cases; failure to respond results in automatic approval

PBMs are banned from retaliating against pharmacies or prescribers through network termination, reimbursement reductions, targeted audits, or claims processing delays, with a 180-day presumption of retaliation for adverse actions

PBMs must report annually to the Department of Commerce and Insurance on prior authorization response times, approval/denial rates, formulary exception requests, and aggregate rebate and fee categories

Violations constitute unfair trade practices subject to civil penalties up to $10,000 per violation, and affected pharmacies or prescribers may sue for injunctive relief and actual damages; effective July 1, 2026