Amends TCA Title 4; Title 47, Chapter 18 and Title 56.

This bill requires a health plan or pharmacy benefits manager to furnish, upon request of an enrollee, enrollee's healthcare provider, or authorized representative of an enrollee, certain cost, benefit, and coverage data (described below) to the enrollee, enrollee's healthcare provider, or authorized representative of the enrollee and to ensure that the data is accurate as of the most recent change to the data that was made prior to the date of request, provided in real time, and provided in the format designated by the requesting party (subject to certain industry standards regarding forma). A health plan or pharmacy benefits manager that receives a request for data that complies with this bill must provide the following data for each drug covered under the enrollee's health plan: (1) The enrollee's eligibility information for the drug; (2) A list of any clinically appropriate alternatives to drugs covered under the enrollee's health plan; (3) Cost-sharing information for the drugs and the clinically appropriate alternatives, including a description of any variance in cost-sharing based on pharmacy, whether retail or mail order, or healthcare provider dispensing or administering the drug or alternatives; and (4) Applicable utilization management requirements for the drugs or clinically appropriate alternatives, including prior authorization, step therapy, quantity limits, and site-of-service restrictions. This bill requires a health plan or pharmacy benefits manager to furnish the data regardless of whether the request is made using the drug's unique billing code, such as a national drug code number or Healthcare Common Procedure Coding System (HCPCS) code, or using a descriptive term, such as the drug's brand name or generic name. This bill prohibits a health plan or pharmacy benefits manager from denying or delaying a request based on the method used to make the request as a means to avoid sharing the data. This bill also prohibits a health plan or pharmacy benefits manager that furnishes data under this bill from: (1) Restricting, prohibiting, or otherwise hindering a healthcare provider from communicating or sharing: (A) The data; (B) Additional information on lower-cost or clinically appropriate alternative drugs, whether or not the drugs are covered under the enrollee's plan; or (C) Additional payment or cost-sharing information that may reduce the patient's out-of-pocket costs, such as cash price or patient assistance, and support programs sponsored by a manufacturer, foundation, or other entity; (2) Except as may be required by law, interfering with, preventing, or materially discouraging access to, exchange of, or the use of the data, including: (A) Charging fees; (B) Failing to respond to a request at the time made when such a response is reasonably possible; (C) Implementing technology in nonstandard ways; or (D) Instituting enrollee consent requirements, processes, policies, procedures, or renewals that are likely to substantially increase the complexity or burden of accessing, exchanging, or using the data; or (3) Penalizing a healthcare provider for: (A) Disclosing the information described above in (1)(A)-(C) to an enrollee; or (B) Prescribing, administering, or ordering a clinically appropriate or lower-cost alternative drug.