The Tennessee Department of Commerce and Insurance (TDCI) has scheduled a public rulemaking hearing for Monday, Oct. 26, 2026, at 9 a.m. Central on a proposed new rule chapter about step therapy. The hearing is set for Conference Room 1-A of the Davy Crockett Tower, 500 James Robertson Parkway, in Nashville.
What step therapy is
Step therapy, sometimes called “fail first,” is when a health plan asks a patient to try one medication before it will cover another. The proposed rule cites Tennessee’s step therapy statutes, T.C.A. §§ 56-7-3501 through 56-7-3504, and focuses on making the exception request easier to find and use.
What the proposed rule says
The notice proposes a new Chapter 0780-01-96, titled “Step Therapy.” It would apply to health carriers, health benefit plans, and utilization review organizations that cover prescription drugs from or into Tennessee under a policy that meets the statutory definition of a step therapy protocol in T.C.A. § 56-7-3504, regardless of what the plan calls the policy.
If one of those plans denies a drug through step therapy, it would have to provide a clear, prominent, and readily accessible exception form that a patient or prescriber can submit on a form or electronically. The form would have to:
- Be linked on the plan’s website and clearly titled “Step Therapy Exception Request”.
- Be submittable on a form or through an electronic process from the plan’s website.
- Include an area to mark the request as an urgent care request from a provider or patient.
- List a phone number, fax number, mailing address, and email address for the department that reviews exception requests.
Who it would not apply to
The proposed chapter excludes TennCare, the CoverKids program, and the Access Tennessee Act program. If your coverage comes through one of those, different rules apply.
How to take part
According to the notice, the hearing will be conducted under the Uniform Administrative Procedures Act, T.C.A. § 4-5-204, and copies of the notice are available from the listed Insurance Division contact. The notice asks people with disabilities who need aid to participate to contact TDCI’s ADA contact at least 10 days before the hearing. Patients, prescribers, and pharmacists who have struggled to find an exception form are the people regulators most need to hear from.
What to do if a medication is denied today
- Ask your plan, in writing, why the drug was denied and whether step therapy applies.
- Ask your prescriber to file an exception request and note if it is urgent.
- Keep copies of every denial letter and submission date.
- If you have questions about your policy, TDCI’s consumer line is 615-741-2218 or 1-800-342-4029.
For background on Tennessee health coverage, see TDCI’s Health Insurance 101 page lists ACA rating-area carriers and No Surprises links. and TDCI says healthcare sharing ministries are not insurance — help with bills is voluntary.. If you need to escalate a problem, How Tennesseans file an insurance complaint with TDCI’s Consumer Insurance Services. walks through the steps.
Related reading from All Seasons
- TDCI’s Health Insurance 101 page lists ACA rating-area carriers and No Surprises links.
- How Tennesseans file an insurance complaint with TDCI’s Consumer Insurance Services.
- TDCI says healthcare sharing ministries are not insurance — help with bills is voluntary.
Free policy review
All Seasons Insurance Group offers a free personal policy review. Call 865-263-1400 or visit asigtn.com/get-a-quote/. This article is informational only and does not promise coverage or eligibility; your policy forms control. Seasons change. So should your coverage.
When is TDCI’s step therapy rulemaking hearing?
Monday, Oct. 26, 2026, at 9 a.m. Central, in Conference Room 1-A of the Davy Crockett Tower, 500 James Robertson Parkway, Nashville.
What rule chapter is proposed?
A new Chapter 0780-01-96, titled Step Therapy.
Who would the rule apply to?
Health carriers, health benefit plans, and utilization review organizations that cover prescription drugs from or into Tennessee using a step therapy protocol.
What would the exception form have to include?
A website link and the title Step Therapy Exception Request, a paper or electronic submission option, an urgent-request box, and phone, fax, mail, and email contacts.
Does the rule apply to TennCare?
No. The proposed chapter excludes TennCare, CoverKids, and the Access Tennessee Act program.
Is the rule in effect now?
No. It is a proposed rule with a public hearing scheduled for Oct. 26, 2026.
Who can I call with a health policy question?
TDCI’s consumer line is 615-741-2218 or 1-800-342-4029.
How can All Seasons help after reading this?
Call 865-263-1400 or visit asigtn.com/get-a-quote/ for a free personal policy review. Informational only; no coverage promises. Seasons change. So should your coverage.
